Healthcare Provider Details

I. General information

NPI: 1295332781
Provider Name (Legal Business Name): MARTHA'S HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEW YORK AVE NE # DC
WASHINGTON DC
20002-1848
US

IV. Provider business mailing address

8701 PARLIAMENT DR
SPRINGFIELD VA
22151-1224
US

V. Phone/Fax

Practice location:
  • Phone: 240-423-8469
  • Fax:
Mailing address:
  • Phone: 240-423-8469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: ATIM TENDOH KIMBENG
Title or Position: CEO
Credential:
Phone: 240-423-8469