MEDICARE: MARYJO HOME CARE, 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	251E00000X	Home Health Agency	21003601	PA

General Provider Information

NPI Number	:	1679866750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYJO HOME CARE, LLC

Provider Business Mailing Address
First Line	:	5010 COTTAGE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-2110
Country	:	US
Telephone Number	:	215-667-1288
Fax Number	:

Provider Business Practice Location Address
First Line	:	5010 COTTAGE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-2110
Country	:	US
Telephone Number	:	215-667-1288
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. MARIELA C MARTINEZ
Credential	:
Telephone Number	:	215-667-1288

Provider Enumeration Date	:	05/23/2011
Last Update Date	:	05/23/2011

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