Healthcare Provider Details

I. General information

NPI: 1710988753
Provider Name (Legal Business Name): MARTHA AND MARY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 06/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19160 FRONT ST NE
POULSBO WA
98370-0127
US

IV. Provider business mailing address

19160 FRONT ST NE PO BOX 127
POULSBO WA
98370-0127
US

V. Phone/Fax

Practice location:
  • Phone: 360-779-7500
  • Fax:
Mailing address:
  • Phone: 360-779-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1216
License Number StateWA

VIII. Authorized Official

Name: MS. LYNETTE L LADENBURG
Title or Position: CEO
Credential:
Phone: 360-779-7500