Provider Demographics
NPI:1528711967
Name:MARTIN, PATRICE M
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3128
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77383-3128
Mailing Address - Country:US
Mailing Address - Phone:832-463-0841
Mailing Address - Fax:
Practice Address - Street 1:8307 LAVENDER ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77016-5735
Practice Address - Country:US
Practice Address - Phone:832-463-0841
Practice Address - Fax:832-266-0513
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home