Provider Demographics
NPI:1093002917
Name:MECCA GROUP
Entity Type:Organization
Organization Name:MECCA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-464-8898
Mailing Address - Street 1:1213 PATRICIA LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042
Mailing Address - Country:US
Mailing Address - Phone:214-809-6170
Mailing Address - Fax:972-767-4848
Practice Address - Street 1:1213 PATRICIA LN
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042
Practice Address - Country:US
Practice Address - Phone:214-809-6170
Practice Address - Fax:972-767-4848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MECCA GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care