=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124428842
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARTIN SENIOR CITIZENS CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2014
-----------------------------------------------------
Last Update Date | 08/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 WALKER STREET
-----------------------------------------------------
City | TRINITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-594-2625
-----------------------------------------------------
Fax | 936-594-7456
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | POST OFFICE BOX 1999 400 WALKER STREET
-----------------------------------------------------
City | TRINITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-594-2625
-----------------------------------------------------
Fax | 936-594-7456
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VOLUNTEER TREASURER
-----------------------------------------------------
Name | MS. SUSAN MANN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 936-594-2625
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------