1124276068 NPI number — MARTIN FAMILY SUPPORT SERVICES

Table of content: (NPI 1124276068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124276068 NPI number — MARTIN FAMILY SUPPORT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN FAMILY SUPPORT SERVICES
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:
Provider Other Organization Name Type Code:
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:
1124276068
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
248 BLANKENSHIP ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAIN DEALING
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-326-4623
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
248 BLANKENSHIP
Provider Second Line Business Practice Location Address:
248 BLANKENSHIP
Provider Business Practice Location Address City Name:
PLAIN DEALING
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-326-4623
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
CHINKESHA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
318-326-4623

Provider Taxonomy Codes

  • Taxonomy code: 251T00000X , with the licence number:  15079 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 15079 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com