MEDICARE: MARLY HOMECARE SERVICES LLC

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	251C00000X	Developmentally Disabled Services Day Training Agency	234384	FL
2	253Z00000X	In Home Supportive Care Agency
3	311ZA0620X	Adult Care Home Facility	234384	FL

General Provider Information

NPI Number	:	1467816751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARLY HOMECARE SERVICES LLC

Provider Business Mailing Address
First Line	:	2669 FOREST HILL SUITE 112
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-3673
Country	:	US
Telephone Number	:	561-537-6306
Fax Number	:

Provider Business Practice Location Address
First Line	:	3355 LAKE WORTH RD STE 4
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-3673
Country	:	US
Telephone Number	:	561-537-6306
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATION
Name	:	MS. MARLY JEAN
Credential	:
Telephone Number	:	561-537-6306

Provider Enumeration Date	:	04/12/2016
Last Update Date	:	05/15/2016

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