MEDICARE: MARY OAKS HOME CARE LLP

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1881429439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY OAKS HOME CARE LLP

Provider Business Mailing Address
First Line	:	4930 ILLINOIS RD STE 6
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-5105
Country	:	US
Telephone Number	:	888-299-4422
Fax Number	:

Provider Business Practice Location Address
First Line	:	4930 ILLINOIS RD STE 6
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-5105
Country	:	US
Telephone Number	:	888-889-8963
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SHUNTEA JENKINS
Credential	:
Telephone Number	:	260-994-0202

Provider Enumeration Date	:	09/04/2024
Last Update Date	:	11/06/2025

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