Healthcare Provider Details

I. General information

NPI: 1255495842
Provider Name (Legal Business Name): MAROLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 ATRISCO DR., NW
ALBUQUERQUE NM
87120-4903
US

IV. Provider business mailing address

3721 RUTLEDGE ROAD. NE
ALBUQUERQUE NM
87109-5566
US

V. Phone/Fax

Practice location:
  • Phone: 505-839-9888
  • Fax: 505-839-7787
Mailing address:
  • Phone: 505-796-3200
  • Fax: 505-796-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number000D4636
License Number StateNM

VIII. Authorized Official

Name: MR. SHAWN W. RICKETTS
Title or Position: CFO
Credential:
Phone: 505-796-3200