Provider Demographics
NPI:1043316292
Name:MISSION MEDICAL ENTERPRISES, INC.
Entity Type:Organization
Organization Name:MISSION MEDICAL ENTERPRISES, INC.
Other - Org Name:HANFORD NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-625-4003
Mailing Address - Street 1:1007 W LACEY BLVD
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-4331
Mailing Address - Country:US
Mailing Address - Phone:559-582-2871
Mailing Address - Fax:559-582-5853
Practice Address - Street 1:420 E MURRAY AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5053
Practice Address - Country:US
Practice Address - Phone:559-625-4003
Practice Address - Fax:559-625-4113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000529314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT06288JMedicaid
CA056288Medicare ID - Type UnspecifiedPROVIDER NUMBER