Healthcare Provider Details

I. General information

NPI: 1134413842
Provider Name (Legal Business Name): MARINELLA'S ANGELS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 MAIN ST
DOBBS FERRY NY
10522-1609
US

IV. Provider business mailing address

82 MAIN ST
DOBBS FERRY NY
10522-1609
US

V. Phone/Fax

Practice location:
  • Phone: 914-693-1625
  • Fax: 914-693-1626
Mailing address:
  • Phone: 914-693-1625
  • Fax: 914-693-1626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1260L001
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ROSANNA HENNESSY
Title or Position: OFFICE MANAGER
Credential:
Phone: 914-693-1625