Provider Demographics
NPI:1659545069
Name:MONES JOHN MOHSENI AND MINA MOHSENI
Entity Type:Organization
Organization Name:MONES JOHN MOHSENI AND MINA MOHSENI
Other - Org Name:LIBERTY HOMES HATHAWAY ICF/DD-H
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSEE/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MONES JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHSENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-278-8908
Mailing Address - Street 1:19834 HATHAWAY AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2313
Mailing Address - Country:US
Mailing Address - Phone:510-278-8908
Mailing Address - Fax:510-278-8908
Practice Address - Street 1:19834 HATHAWAY AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2313
Practice Address - Country:US
Practice Address - Phone:510-278-8908
Practice Address - Fax:510-278-8908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000119315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities