MEDICARE: MARCED, INC

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	310400000X	Assisted Living Facility	AL8379	FL

General Provider Information

NPI Number	:	1528403326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCED, INC

Provider Business Mailing Address
First Line	:	1645 BARTLETT AVE
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-3616
Country	:	US
Telephone Number	:	904-264-9570
Fax Number	:	904-264-9570

Provider Business Practice Location Address
First Line	:	1645 BARTLETT AVE
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-3616
Country	:	US
Telephone Number	:	904-264-9570
Fax Number	:	904-264-9570

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAULINE DYER
Credential	:
Telephone Number	:	904-708-8471

Provider Enumeration Date	:	05/07/2013
Last Update Date	:	05/07/2013

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