Provider Demographics
NPI:1447858386
Name:MARTY'S PERSONAL CARE LLC
Entity type:Organization
Organization Name:MARTY'S PERSONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:FALIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-478-8737
Mailing Address - Street 1:711 SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-5836
Mailing Address - Country:US
Mailing Address - Phone:937-478-8737
Mailing Address - Fax:
Practice Address - Street 1:711 SALEM AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-5836
Practice Address - Country:US
Practice Address - Phone:937-478-8737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5708747Medicaid