Healthcare Provider Details

I. General information

NPI: 1942117130
Provider Name (Legal Business Name): MARYNAN HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1453 FLAT CREEK RD
LANCASTER SC
29720-7663
US

IV. Provider business mailing address

1453 FLAT CREEK RD
LANCASTER SC
29720-7663
US

V. Phone/Fax

Practice location:
  • Phone: 803-320-8721
  • Fax:
Mailing address:
  • Phone: 803-320-8721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE TUCKER
Title or Position: OWNER
Credential:
Phone: 803-320-8721