Provider Demographics
NPI:1942981154
Name:MARTHA LLC
Entity Type:Organization
Organization Name:MARTHA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FANTAHUN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:GUYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-277-5471
Mailing Address - Street 1:15592 E 12TH AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-7364
Mailing Address - Country:US
Mailing Address - Phone:720-277-5471
Mailing Address - Fax:
Practice Address - Street 1:15592 E 12TH AVE APT 301
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-7364
Practice Address - Country:US
Practice Address - Phone:720-277-5471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)