Provider Demographics
NPI:1275853491
Name:MONA MENTORS COMMUNITY AGENCY
Entity Type:Organization
Organization Name:MONA MENTORS COMMUNITY AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:SWAFFORD
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:CRISIS CHAPLAIN
Authorized Official - Phone:832-524-7884
Mailing Address - Street 1:1339 MACCLESBY LANE
Mailing Address - Street 2:
Mailing Address - City:CHANNEVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530
Mailing Address - Country:US
Mailing Address - Phone:832-524-7884
Mailing Address - Fax:713-266-2090
Practice Address - Street 1:6420 RICHMOND AVENDUE
Practice Address - Street 2:SUITE 602
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057
Practice Address - Country:US
Practice Address - Phone:832-524-7884
Practice Address - Fax:713-266-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle