Provider Demographics
NPI:1588968937
Name:ANDREA MARTIN HOME, INC
Entity type:Organization
Organization Name:ANDREA MARTIN HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:EDITH
Authorized Official - Last Name:FARJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-718-4560
Mailing Address - Street 1:17851 SW 11TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-4412
Mailing Address - Country:US
Mailing Address - Phone:786-718-4560
Mailing Address - Fax:
Practice Address - Street 1:17851 SW 11TH CT
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-4412
Practice Address - Country:US
Practice Address - Phone:786-718-4560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL119003104A0625X, 3104A0630X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances