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General NPI Number Information
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NPI Number | 1528107505
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Entity Type | Organization
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Legal Business Name | .MARTHA'S GROUP HOMES, INC.
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 303 S SHORE DR
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City | JACKSONVILLE
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State | NC
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Zip | 28540-5647
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Country | US
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Telephone | 910-938-0670
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Fax | 910-938-1229
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Provider Business Mailing Address
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Address Line | 516 E SPRINGHILL TER
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City | JACKSONVILLE
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State | NC
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Zip | 28546-7366
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Country | US
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Telephone | 910-938-0670
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Fax | 910-938-1229
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Authorized Official
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Title or Position | DIRECTOR-OWNER
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Name | MRS. MARTHA WOOTEN SHEPARD
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Credential | RN, BA, QMHP, QDD
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Telephone | 910-938-0670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | MHL-067-069
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License Number State | NC
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