Basic Information
| Provider Information | |||||||||
| NPI: | 1487778312 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MARTINS' ACHIEVEMENT PLACE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MARTINS' ACHIEVEMENT CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7806 UPLANDS WAY, SUITE C | ||||||||
| Address2: | |||||||||
| City: | CITRUS HEIGHTS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169676253 | ||||||||
| FaxNumber: | 9169679413 | ||||||||
| Practice Location | |||||||||
| Address1: | 7806 UPLANDS WAY, SUITE C | ||||||||
| Address2: | |||||||||
| City: | CITRUS HEIGHTS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169676253 | ||||||||
| FaxNumber: | 9169679413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | THOMPSON | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | QUALITY ASSURANCE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9169676253 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MARTINS' ACHIEVEMENT PLACE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320600000X | N | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 322D00000X | N | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 322D00000X | CA | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
No ID Information.