NPIMap

Organization Active NPI

Martin House

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Burlington, CO
National Provider Identifier
1093929465
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
1167 Issued in CO
Legal business name
MARTIN HOUSE
Practice address
567 18TH St
Burlington, CO 80807-1521
Phone
(719) 346-5367
Fax
(719) 346-6010
NPI assigned
May 9, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cheryl Reese
Title
Executive Director
Phone
(719) 346-5367

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 1167 CO Primary

Addresses

Primary practice location

567 18TH St
Burlington, CO 80807-1521

Mailing address

1776 Martin Ave
Burlington, CO 80807-1540
Phone (719) 346-8550

Other identifiers 1

IdentifierTypeStateIssuer
09141912MedicaidCO

National Provider Directory

National Provider Directory
Tax ID family
Dynamic Dimensions Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1776 Martin Ave
Burlington, CO 80807

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093929465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 MARTIN AVE",
            "city": "BURLINGTON",
            "state": "CO",
            "postal_code": "808071540",
            "telephone_number": "719-346-8550",
            "fax_number": "719-346-6010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "567 18TH ST",
            "city": "BURLINGTON",
            "state": "CO",
            "postal_code": "808071521",
            "telephone_number": "719-346-5367",
            "fax_number": "719-346-6010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REESE",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "719-346-5367"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CO",
            "license": "1167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09141912",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.