Provider Demographics
NPI:1235836230
Name:MARYS AMAZEN TRANSPORTATION
Entity type:Organization
Organization Name:MARYS AMAZEN TRANSPORTATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:STEELE-MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MHSA
Authorized Official - Phone:551-226-2448
Mailing Address - Street 1:4804 PAGE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8582
Mailing Address - Country:US
Mailing Address - Phone:551-226-2448
Mailing Address - Fax:
Practice Address - Street 1:4819 EMPEROR BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-0089
Practice Address - Country:US
Practice Address - Phone:551-226-2448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARYS AMAZEN HOMECARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-09
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251S00000XAgenciesCommunity/Behavioral Health
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC84-191-2546OtherPECOS
NC84-1912546Medicaid