Healthcare Provider Details

I. General information

NPI: 1396287702
Provider Name (Legal Business Name): MARTINS MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 SW NYE AVE
PENDLETON OR
97801-9405
US

IV. Provider business mailing address

1115 SW NYE AVE
PENDLETON OR
97801
US

V. Phone/Fax

Practice location:
  • Phone: 541-429-4146
  • Fax:
Mailing address:
  • Phone: 541-429-4146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number519145
License Number StateOR

VIII. Authorized Official

Name: MR. MICHAEL KING II
Title or Position: OWNER
Credential:
Phone: 541-429-4146