Marty'S Miraculous Private Care LLC

Primary specialty

Personal Care AttendantTaxonomy code 3747P1801X

Legal business name

MARTY'S MIRACULOUS PRIVATE CARE LLC

Practice address

3431 Bridgeland Dr Ste K
Bridgeton, MO 63044-2648

Phone

(314) 906-1020

NPI assigned

Oct 22, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mona N Banks

Title

Owner

Phone

(314) 906-1020

Specialties & licenses 3

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729555200000",
    "number": "1043031032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3431 BRIDGELAND DR STE K",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442648",
            "telephone_number": "314-906-1020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3431 BRIDGELAND DR STE K",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442648",
            "telephone_number": "314-906-1020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTY'S MIRACULOUS PRIVATE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-22",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-22",
        "status": "A",
        "authorized_official_last_name": "BANKS",
        "authorized_official_first_name": "MONA",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-906-1020"
    },
    "taxonomies": [
        {
            "code": "372500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chore Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Marshall, PT, DPT
• Anna Leigh Martin, NP
• Kelsey Elaine Martin
• Tiffany M Martin, DPT
• Marty'S Miraculous Care, LLC
• Danielle Mathis, MSN,APRN, FNP-BC
• Richard Anthony Matkowski
• Melanie Matthew, LMSW
• Susan Mattie, RPH
• Daniel T Mattson, MD

• Personal Care Attendant in Bridgeton, MO
• Providers in Bridgeton, MO by specialty
• Personal Care Attendant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.