Mardras Marvelous Mission I LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

MARDRAS MARVELOUS MISSION I LLC

Practice address

3830 Washington Blvd
Ste 109
Saint Louis, MO 63108-3460

Phone

(314) 659-9090

Fax

(314) 833-3170

NPI assigned

Jul 29, 2015

Organization subpart

No

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

Authorized official

Name

Shaunice Shelton, BSN RN

Title

Executive Director

Phone

(314) 659-9090

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1438128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472342400000",
    "number": "1053796219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3830 WASHINGTON BLVD",
            "address_2": "STE 109",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631083460",
            "telephone_number": "636-465-3004",
            "fax_number": "314-833-3170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3830 WASHINGTON BLVD",
            "address_2": "STE 109",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631083460",
            "telephone_number": "314-659-9090",
            "fax_number": "314-833-3170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARDRAS MARVELOUS MISSION I LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-29",
        "last_updated": "2016-08-28",
        "status": "A",
        "authorized_official_last_name": "SHELTON",
        "authorized_official_first_name": "SHAUNICE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "314-659-9090",
        "authorized_official_credential": "BSN RN"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DHSS",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Marcus, MD
• Michele C Marcus, NP
• Marden Dental
• Marsha L Marden, DMD
• Deangelo Leon Mardis Jr.
• Suneetha Mare, PHD, RPH
• Robert Mareing, AUD
• Alexander Hua-Ming Marelich, MD
• Joan B Marentette II
• Cynthia Lee Marfisi, CT(ASCP)

• In Home Supportive Care Agency in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• In Home Supportive Care Agency in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2016; 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.