Provider Demographics
NPI:1275353740
Name:MARTHA'S RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:MARTHA'S RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAFFIATU
Authorized Official - Middle Name:S
Authorized Official - Last Name:TUNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-217-6996
Mailing Address - Street 1:22958 W PIMA ST
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-8734
Mailing Address - Country:US
Mailing Address - Phone:480-217-6996
Mailing Address - Fax:480-452-0243
Practice Address - Street 1:4612 N 94TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-1330
Practice Address - Country:US
Practice Address - Phone:480-217-6996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness