Healthcare Provider Details

I. General information

NPI: 1538562681
Provider Name (Legal Business Name): MARINA HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 ST LAWRENCE DR SUITE 107
TIFFIN OH
44883-8312
US

IV. Provider business mailing address

709 W WASHINGTON ST
SANDUSKY OH
44870-2334
US

V. Phone/Fax

Practice location:
  • Phone: 419-455-8700
  • Fax: 419-455-8701
Mailing address:
  • Phone: 888-502-4312
  • Fax: 419-502-4512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberHMER.22545
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberHMER.22545
License Number StateOH

VIII. Authorized Official

Name: MR. MICHAEL J WILL
Title or Position: PRESIDENT
Credential:
Phone: 888-502-4312