Erica Nicole Martin

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

I000000022582 Issued in TN

Practice address

364 N Parkway Ste 8
Jackson, TN 38305-2874

Phone

(731) 431-7241

Fax

(731) 736-1111

NPI assigned

Oct 16, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Serentiy Living Homecare

  • In Home Supportive Care Agency
  • Jackson, TN
  • NPI 1295583128
  NPD Authorized official

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

{
    "created_epoch": "1697414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1174305007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "364 N PARKWAY STE 8",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052874",
            "telephone_number": "731-736-1005",
            "fax_number": "731-736-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "364 N PARKWAY STE 8",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052874",
            "telephone_number": "731-431-7241",
            "fax_number": "731-736-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "ERICA",
        "middle_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-16",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "TN",
            "license": "I000000022582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q087092",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paulette Marshall, CASE MANAGER
• Maria Del Rosario Marshel, DO
• Martin E Cleveland PHD PLLC
• Andrew Martin
• Elizabeth M Martin
• Khalil Syntrel Martin
• Latesha Martin, FAM PRESERV SPEC
• Michael James Martin, D.O.
• Susan C Martin, FNP-BC
• Trent Wayne Martin, OD

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Jackson, TN
• Providers in Jackson, TN by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; 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.