Provider Demographics
NPI:1033509252
Name:MARTHA & MARY HOME AND COMMUNITY SERVICES
Entity Type:Organization
Organization Name:MARTHA & MARY HOME AND COMMUNITY SERVICES
Other - Org Name:MARTHA & MARY AT HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SOLVIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-779-7500
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-0127
Mailing Address - Country:US
Mailing Address - Phone:360-779-7500
Mailing Address - Fax:
Practice Address - Street 1:19160 FRONT STREET NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-0127
Practice Address - Country:US
Practice Address - Phone:360-779-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTHA & MARY LUTHERAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60123737251B00000X, 251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health