Provider Demographics
NPI:1942947817
Name:MARTHA ASSISTED LIVING
Entity type:Organization
Organization Name:MARTHA ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALM
Authorized Official - Prefix:
Authorized Official - First Name:VIDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAYAWARDANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-326-7425
Mailing Address - Street 1:3613 DELLABROOKE ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1028
Mailing Address - Country:US
Mailing Address - Phone:301-326-7425
Mailing Address - Fax:
Practice Address - Street 1:3613 DELLABROOKE ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1028
Practice Address - Country:US
Practice Address - Phone:301-326-7425
Practice Address - Fax:240-833-3256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness