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General NPI Number Information
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NPI Number | 1396287702
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Entity Type | Organization
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Legal Business Name | MARTINS MANOR
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 1115 SW NYE AVE
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City | PENDLETON
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State | OR
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Zip | 97801-9405
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Country | US
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Telephone | 541-429-4146
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 SW NYE AVE
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City | PENDLETON
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State | OR
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Zip | 97801
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Country | US
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Telephone | 541-429-4146
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL KING II
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Credential |
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Telephone | 541-429-4146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 519145
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License Number State | OR
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