Provider Demographics
NPI:1306325295
Name:MARTY-KRAMER GROUP, LLC
Entity type:Organization
Organization Name:MARTY-KRAMER GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELIJAH
Authorized Official - Middle Name:LAKE
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-285-2453
Mailing Address - Street 1:863 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-2824
Mailing Address - Country:US
Mailing Address - Phone:608-647-5319
Mailing Address - Fax:
Practice Address - Street 1:24895 CLARY LANE
Practice Address - Street 2:
Practice Address - City:SEXTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:53584
Practice Address - Country:US
Practice Address - Phone:608-383-1479
Practice Address - Fax:608-383-1480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility