Provider Demographics
NPI:1013287358
Name:MARTHA KLAY, LLC
Entity Type:Organization
Organization Name:MARTHA KLAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLAY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, RN
Authorized Official - Phone:201-300-6650
Mailing Address - Street 1:115 EAST ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1433
Mailing Address - Country:US
Mailing Address - Phone:413-429-6165
Mailing Address - Fax:201-773-0182
Practice Address - Street 1:115 EAST ST
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1433
Practice Address - Country:US
Practice Address - Phone:413-429-6165
Practice Address - Fax:201-773-0182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158733164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004202800Medicaid
MA0723908Medicaid
MANP5340Medicare PIN
CT500000733Medicare PIN