Healthcare Provider Details

I. General information

NPI: 1851208813
Provider Name (Legal Business Name): MARILYNS KITCHEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 RIVERS AVE
NORTH CHARLESTON SC
29406-6027
US

IV. Provider business mailing address

103 DAVIDSON DR
LADSON SC
29456-3307
US

V. Phone/Fax

Practice location:
  • Phone: 404-992-5719
  • Fax:
Mailing address:
  • Phone: 404-992-5719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: NIKEVA MEGAN MCPHERSON
Title or Position: OWNER
Credential:
Phone: 404-992-5719