MEDICARE: MARTA NJOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide		IL

General Provider Information

NPI Number	:	1205584943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTA NJOS

Provider Business Mailing Address
First Line	:	7150 FOREST GLEN DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61114-8032
Country	:	US
Telephone Number	:	779-772-3638
Fax Number	:

Provider Business Practice Location Address
First Line	:	7150 FOREST GLEN DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61114-8032
Country	:	US
Telephone Number	:	779-772-3638
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2022
Last Update Date	:	03/11/2022

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Directions to “ MARTA NJOS ” Practice Location

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