MEDICARE: MARYS 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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1891901476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYS HOME CARE LLC

Provider Business Mailing Address
First Line	:	1203 STEGER RD NW
Second Line	:	PO BOX 832
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308-5307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1203 STEGER RD NW
Second Line	:
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308-5307
Country	:	US
Telephone Number	:	320-763-9776
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARY KAY OLERUD
Credential	:
Telephone Number	:	320-763-9776

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/22/2020

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