Provider Demographics
NPI:1639835374
Name:MARTIN'S MANOR, LLC
Entity Type:Organization
Organization Name:MARTIN'S MANOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MPA
Authorized Official - Phone:678-499-8308
Mailing Address - Street 1:1740 HUDSON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6331
Mailing Address - Country:US
Mailing Address - Phone:678-499-8308
Mailing Address - Fax:678-884-5621
Practice Address - Street 1:909 RING NECKED CT
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4475
Practice Address - Country:US
Practice Address - Phone:678-499-8308
Practice Address - Fax:678-884-5621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health