Provider Demographics
NPI:1437161452
Name:JOHN MUIR HEALTH
Entity Type:Organization
Organization Name:JOHN MUIR HEALTH
Other - Org Name:JOHN MUIR HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-947-5234
Mailing Address - Street 1:2298 PIKE CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-1251
Mailing Address - Country:US
Mailing Address - Phone:925-674-2560
Mailing Address - Fax:925-674-2725
Practice Address - Street 1:2298 PIKE CT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1251
Practice Address - Country:US
Practice Address - Phone:924-674-2560
Practice Address - Fax:925-674-2725
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN MUIR HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-12
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA70084FMedicaid
CA057276OtherBLUE CROSS OF CA
CAZZZ97731ZOtherBLUE SHIELD OF CALIF
CA057276OtherBLUE CROSS OF CA