Provider Demographics
NPI:1821261389
Name:S MARTIN LLC
Entity Type:Organization
Organization Name:S MARTIN LLC
Other - Org Name:INNER WEALTH RESIDENTIAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-201-1626
Mailing Address - Street 1:209 KINDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6612
Mailing Address - Country:US
Mailing Address - Phone:919-201-1626
Mailing Address - Fax:919-794-4781
Practice Address - Street 1:2 ISAACS WAY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-3465
Practice Address - Country:US
Practice Address - Phone:919-688-1830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-05
Last Update Date:2008-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children