Provider Demographics
NPI:1851547566
Name:MARTIN FAMILY SUPPORT SERVICES
Entity Type:Organization
Organization Name:MARTIN FAMILY SUPPORT SERVICES
Other - Org Name:MARTIN FAMILY SUPPORT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAPLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-326-4623
Mailing Address - Street 1:P.O. BOX 515
Mailing Address - Street 2:248 BLANKENSHIP ROAD
Mailing Address - City:PLAIN DEALING
Mailing Address - State:LA
Mailing Address - Zip Code:71064
Mailing Address - Country:US
Mailing Address - Phone:318-326-4623
Mailing Address - Fax:
Practice Address - Street 1:248 BLANKENSHIP ROAD
Practice Address - Street 2:
Practice Address - City:PLAIN DEALING
Practice Address - State:LA
Practice Address - Zip Code:71064
Practice Address - Country:US
Practice Address - Phone:318-326-4623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15079251E00000X, 251T00000X
LA20086251G00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider OrganizationGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA15079OtherCHILDREN'S CHOICE
LA0007762Medicaid
LA0007764Medicaid