Healthcare Provider Details

I. General information

NPI: 1588930176
Provider Name (Legal Business Name): MARIANAS HOME CARE & HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STE#201 GHIYEGHI ST. SAN JOSE MARIANAS HEALTH LLC BUILDING
SAIPAN MP
96950-8903
US

IV. Provider business mailing address

PO BOX 10003
SAIPAN MP
96950-8903
US

V. Phone/Fax

Practice location:
  • Phone: 670-233-4646
  • Fax: 670-233-4648
Mailing address:
  • Phone: 670-233-4646
  • Fax: 670-233-4648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number20141-0002-1
License Number StateMP

VIII. Authorized Official

Name: MRS. EVELYN P. DE BELEN
Title or Position: BILLING SPECIALIST
Credential:
Phone: 670-233-4646