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General NPI Number Information
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NPI Number | 1578752770
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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 | 10/24/2007
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Last Update Date | 10/24/2007
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Provider Practice Location 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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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 | CEO
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Name | THOMAS TREVOUR SHEPARD
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Credential | MFA,QMHP
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | PENDING
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License Number State | NC
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