Provider Demographics
NPI:1386845287
Name:CHRISTY MARVIN
Entity Type:Organization
Organization Name:CHRISTY MARVIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH AID
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:EARLEAN
Authorized Official - Last Name:MARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:208-550-2638
Mailing Address - Street 1:1111 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEISER
Mailing Address - State:ID
Mailing Address - Zip Code:83672-2437
Mailing Address - Country:US
Mailing Address - Phone:208-549-2076
Mailing Address - Fax:
Practice Address - Street 1:1111 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEISER
Practice Address - State:ID
Practice Address - Zip Code:83672-2437
Practice Address - Country:US
Practice Address - Phone:208-549-2076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDID OOO16921203311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility