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General NPI Number Information
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NPI Number | 1689521452
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Entity Type | Organization
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Legal Business Name | MARA VENTURE CAPITAL LLC
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Dates
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Enumeration Date | 03/11/2026
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Last Update Date | 03/11/2026
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Provider Practice Location Address
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Address Line | 60 MCLEAN ST
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-3308
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Country | US
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Telephone | 313-438-8788
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Fax |
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Provider Business Mailing Address
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Address Line | 6311 HAGGERTY RD # 722
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City | W BLOOMFIELD
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State | MI
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Zip | 48322-5031
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Country | US
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Telephone | 313-438-8788
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TAMARA M EVANS
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Credential |
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Telephone | 313-438-8788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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