Provider Demographics
NPI:1174893226
Name:MARYWOOD HOME HEALTH
Entity type:Organization
Organization Name:MARYWOOD HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED
Authorized Official - Phone:616-643-0305
Mailing Address - Street 1:2025 EAST FULTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-643-0305
Mailing Address - Fax:
Practice Address - Street 1:2025 E FULTON ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3898
Practice Address - Country:US
Practice Address - Phone:616-643-0305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health