Individual
GARY ROBERT MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
516 LAUREL LANE, NAPLES, ID 83847
(208) 610-1686
Mailing address
516 LAURAL LN, NAPLES, ID 83847-5190
(208) 610-1686
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
CHF-2918
ID
253Z00000X
In Home Supportive Care Agency
—
—
310400000X
Assisted Living Facility
CHF-2918
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IDTPID006303
—
ID
Enumeration date
12/30/2022
Last updated
02/16/2023
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