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General NPI Number Information
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NPI Number | 1578573952
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Entity Type | Organization
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Legal Business Name | MARIAN HEALTHCARE SERVICES, LLC
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 05/11/2009
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Provider Practice Location Address
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Address Line | 500 E HIGGINS RD SUITE 210
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-1438
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Country | US
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Telephone | 847-290-1740
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Fax | 847-290-1760
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Provider Business Mailing Address
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Address Line | 500 E HIGGINS RD SUITE 210
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-1438
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Country | US
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Telephone | 847-290-1740
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Fax | 847-290-1760
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Authorized Official
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Title or Position | PRESIDENT
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Name | SALVADOR CAOILI SERRANO
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Credential | M.D.
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Telephone | 847-290-1740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1747748
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License Number State | IL
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