MEDICARE: KENYA MARTIN

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	320800000X	Mental Illness Community Based Residential Treatment Facility		AZ

General Provider Information

NPI Number	:	1922897115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENYA MARTIN

Provider Business Mailing Address
First Line	:	7631 W GLOBE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-1679
Country	:	US
Telephone Number	:	623-707-5451
Fax Number	:

Provider Business Practice Location Address
First Line	:	7631 W GLOBE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-1679
Country	:	US
Telephone Number	:	602-830-2084
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2025
Last Update Date	:	05/05/2025

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Directions to “ KENYA MARTIN ” Practice Location

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