Organization
MARTHE'S HOME BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ERICA PETITHOMME (MANAGER)
(305) 523-9475
Entity
Organization
Contact information
Practice address
12339 JEWEL STONE LN, FORT MYERS, FL 33913-6750
(305) 523-9475
(706) 666-0413
Mailing address
4213 BRICKYARD WAY, POWDER SPRINGS, GA 30127-2506
(305) 523-9475
(706) 666-0413
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/23/2024
Last updated
10/01/2024
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