MEDICARE: MARTHA & MARY HOME AND COMMUNITY SERVICES

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	251B00000X	Case Management Agency	60123737	WA
2	251E00000X	Home Health Agency	60123737	WA
3	253Z00000X	In Home Supportive Care Agency	60123737	WA

General Provider Information

NPI Number	:	1033509252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTHA & MARY HOME AND COMMUNITY SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 127
Second Line	:
City	:	POULSBO
State	:	WA
Zip	:	98370-0127
Country	:	US
Telephone Number	:	360-779-7500
Fax Number	:

Provider Business Practice Location Address
First Line	:	19160 FRONT STREET NE
Second Line	:
City	:	POULSBO
State	:	WA
Zip	:	98370-0127
Country	:	US
Telephone Number	:	360-779-7500
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHAD MICHAEL SOLVIE
Credential	:
Telephone Number	:	360-779-7500

Provider Enumeration Date	:	01/26/2015
Last Update Date	:	01/26/2015

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