Healthcare Provider Details

I. General information

NPI: 1881739019
Provider Name (Legal Business Name): MARTIN GRAHAM ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W FANNIN RD
MELISSA TX
75454-2078
US

IV. Provider business mailing address

1100 W FANNIN RD
MELISSA TX
75454-2078
US

V. Phone/Fax

Practice location:
  • Phone: 972-838-9200
  • Fax: 972-838-9204
Mailing address:
  • Phone: 972-838-9200
  • Fax: 972-838-9204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number630173
License Number StateTX

VIII. Authorized Official

Name: MRS. SHERRY LYNN MARTIN
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 972-838-9200