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General NPI Number Information
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NPI Number | 1649608142
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Entity Type | Organization
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Legal Business Name | MARRIOTT HOME CARE, INC
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Dates
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Enumeration Date | 10/18/2013
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 2700 BROADWAY
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-5433
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Country | US
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Telephone | 561-659-3793
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 BROADWAY
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-5433
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Country | US
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Telephone | 561-659-3793
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | PEARL WONG
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Credential | RN
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Telephone | 561-659-3793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL10785
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License Number State | FL
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