=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386284917
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARI CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2020
-----------------------------------------------------
Last Update Date | 06/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 HAMBURG TPKE STE 211
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07470-2049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-321-0010
-----------------------------------------------------
Fax | 975-956-7000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 HAMBURG TPKE STE 211
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07470-2049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-321-0010
-----------------------------------------------------
Fax | 973-956-7000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MEMBER
-----------------------------------------------------
Name | ARI TIKTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-321-0010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------