MEDICARE: MARTHA AND MARY HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	1216	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1216	OTHER	WA	NURSING HOME LICENSE

General Provider Information

NPI Number	:	1710988753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTHA AND MARY HEALTH SERVICES

Provider Business Mailing Address
First Line	:	19160 FRONT ST NE
Second Line	:	PO BOX 127
City	:	POULSBO
State	:	WA
Zip	:	98370-0127
Country	:	US
Telephone Number	:	360-779-7500
Fax Number	:

Provider Business Practice Location Address
First Line	:	19160 FRONT ST NE
Second Line	:
City	:	POULSBO
State	:	WA
Zip	:	98370-0127
Country	:	US
Telephone Number	:	360-779-7500
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. LYNETTE L LADENBURG
Credential	:
Telephone Number	:	360-779-7500

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	06/01/2017

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Directions to “MARTHA AND MARY HEALTH SERVICES ” Practice Location

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