MEDICARE: MARTY HOME CARE

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	251J00000X	Nursing Care Agency	PN. 153487-M-IV	OH

General Provider Information

NPI Number	:	1225459860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTY HOME CARE

Provider Business Mailing Address
First Line	:	5705 TERRACE PARK DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45429-6047
Country	:	US
Telephone Number	:	937-270-8455
Fax Number	:	937-439-0530

Provider Business Practice Location Address
First Line	:	5705 TERRACE PARK DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45429-6047
Country	:	US
Telephone Number	:	937-270-8455
Fax Number	:	937-439-0530

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARLETT RENEE MCDOWELL
Credential	:	LPN
Telephone Number	:	937-270-8455

Provider Enumeration Date	:	12/28/2013
Last Update Date	:	12/28/2013

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Directions to “MARTY HOME CARE ” Practice Location

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