Healthcare Provider Details

I. General information

NPI: 1629418835
Provider Name (Legal Business Name): MARQUIS HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N. MAIN STREET
SPRING VALLEY NY
10977-4020
US

IV. Provider business mailing address

230 N. MAIN STREET
SPRING VALLEY NY
10977-4020
US

V. Phone/Fax

Practice location:
  • Phone: 845-363-8140
  • Fax: 845-363-8141
Mailing address:
  • Phone: 845-363-8140
  • Fax: 845-363-8141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number9655L003
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number9655L002
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number9655L001
License Number StateNY

VIII. Authorized Official

Name: GREGG ROSEN
Title or Position: COO
Credential: MPA
Phone: 845-363-8168