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General NPI Number Information
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NPI Number | 1710988753
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Entity Type | Organization
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Legal Business Name | MARTHA AND MARY HEALTH SERVICES
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Dates
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Enumeration Date | 08/01/2005
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Last Update Date | 06/01/2017
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Provider Practice Location Address
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Address Line | 19160 FRONT ST NE
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City | POULSBO
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State | WA
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Zip | 98370-0127
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Country | US
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Telephone | 360-779-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 19160 FRONT ST NE PO BOX 127
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City | POULSBO
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State | WA
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Zip | 98370-0127
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Country | US
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Telephone | 360-779-7500
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. LYNETTE L LADENBURG
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Credential |
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Telephone | 360-779-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1216
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License Number State | WA
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