Provider Demographics
NPI:1750508818
Name:MARTHA'S VILLAGE AND KITCHEN
Entity Type:Organization
Organization Name:MARTHA'S VILLAGE AND KITCHEN
Other - Org Name:FATHER JOE'S VILLAGES
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:KALKWARF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-347-4741
Mailing Address - Street 1:83791 DATE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4737
Mailing Address - Country:US
Mailing Address - Phone:760-347-4741
Mailing Address - Fax:760-342-2294
Practice Address - Street 1:83791 DATE AVE
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4737
Practice Address - Country:US
Practice Address - Phone:760-347-4741
Practice Address - Fax:760-342-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation