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General NPI Number Information
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NPI Number | 1790120384
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Entity Type | Organization
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Legal Business Name | MARTIN LIVING CORPORATION
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Dates
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Enumeration Date | 05/08/2013
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Last Update Date | 09/02/2014
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Provider Practice Location Address
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Address Line | 61 THOMAS DICKENS RD 61 THOMAS DICKENS ROAD
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City | LILLINGTON
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State | NC
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Zip | 27546-7606
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Country | US
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Telephone | 910-658-1254
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2201 61 THOMAS DICKENS ROAD
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City | LILLINGTON
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State | NC
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Zip | 27546-2201
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Country | US
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Telephone | 910-658-1254
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MISS BARBARA ANN RIDGELL
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Credential |
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Telephone | 910-658-1254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0005X
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Taxonomy Name | Ambulatory Family Planning Facility
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License Number | MHL-043-090
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License Number State | NC
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