1396194528 NPI number — MARTHA'S CARING HOMEMAKERS AND COMPANIONS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396194528 NPI number — MARTHA'S CARING HOMEMAKERS AND COMPANIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTHA'S CARING HOMEMAKERS AND COMPANIONS
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:
1396194528
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 705
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CITRA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32113-0705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-595-1775
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3449 NE 162ND ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CITRA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-595-1775
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RUTLEY
Authorized Official First Name:
MARTHA
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
352-595-1775

Provider Taxonomy Codes

  • Taxonomy code: 372500000X , with the licence number:  234390 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 372600000X , with the licence number: 234390 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376J00000X , with the licence number: 234390 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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