1821261389 NPI number — S MARTIN LLC

Table of content: (NPI 1821261389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821261389 NPI number — S MARTIN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S MARTIN LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INNER WEALTH RESIDENTIAL
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821261389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 KINDLEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27703-6612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-201-1626
Provider Business Mailing Address Fax Number:
919-794-4781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 ISAACS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27713-3465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-688-1830
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
919-201-1626

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)