Provider Demographics
NPI:1295836757
Name:MARK HICKS
Entity Type:Organization
Organization Name:MARK HICKS
Other - Org Name:NAPTIME HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:P
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:BS RRT RCP
Authorized Official - Phone:562-691-7161
Mailing Address - Street 1:1280 W LAMBERT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-2820
Mailing Address - Country:US
Mailing Address - Phone:562-691-7161
Mailing Address - Fax:562-691-7162
Practice Address - Street 1:1280 W LAMBERT RD
Practice Address - Street 2:SUITE B
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-2820
Practice Address - Country:US
Practice Address - Phone:562-691-7161
Practice Address - Fax:562-691-7162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10079550332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME01723GMedicaid
CA4286820001Medicare NSC