Most Relevant Information
Provider Data
| NPI Number: | 1003432667 |
| Provider Name: | JOHN HENRY MARTIN LICO |
| Entity Type: | Individual |
| Taxonomy Code: | 310400000X |
| Specialty: | Assisted Living Facility |
| License Number: | AL11496H |
Most Important Dates
| Enumeration Date: | 06/19/2020 |
| Last Updated: | 06/19/2020 |
Provider Practice Location
15244 W WATSON LN
SURPRISE
AZ
853797040
Practice Location Phone/Fax
| Phone: | 6232279697 |
| Fax: |
Provider Mailing Location
15244 W WATSON LN
SURPRISE
AZ
853797040
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |