Provider Demographics
NPI:1013953611
Name:THE PLACE AT MARTINEZ, LLC
Entity Type:Organization
Organization Name:THE PLACE AT MARTINEZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:W.
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:ODEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-585-4444
Mailing Address - Street 1:1615 PENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-5880
Mailing Address - Country:US
Mailing Address - Phone:615-585-8444
Mailing Address - Fax:615-848-1570
Practice Address - Street 1:409 PLEASANT HOME RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-3523
Practice Address - Country:US
Practice Address - Phone:706-863-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000142535AMedicaid
GA11-5308Medicare ID - Type Unspecified
GA1040940001Medicare NSC