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General NPI Number Information
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NPI Number | 1184730913
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Entity Type | Organization
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Legal Business Name | MARIETTA HEALTHCARE, LLC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 05/17/2016
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Provider Practice Location Address
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Address Line | 117 BARTLETT ST
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City | MARIETTA
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State | OH
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Zip | 45750-2683
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Country | US
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Telephone | 740-373-1867
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Fax |
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Provider Business Mailing Address
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Address Line | 117 BARTLETT ST
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City | MARIETTA
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State | OH
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Zip | 45750-2683
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Country | US
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Telephone | 740-373-1867
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Fax |
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Authorized Official
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Title or Position | ASSISTANT SECRETARY
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Name | MICHAEL T. BERG
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Credential |
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Telephone | 505-468-4752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1270N
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License Number State | OH
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