Provider Demographics
NPI:1659763449
Name:MISSION HOME HEALTH OF RANCHO MIRAGE, INC.
Entity Type:Organization
Organization Name:MISSION HOME HEALTH OF RANCHO MIRAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-757-2700
Mailing Address - Street 1:2385 NORTHSIDE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2727
Mailing Address - Country:US
Mailing Address - Phone:619-757-2700
Mailing Address - Fax:
Practice Address - Street 1:71847 HIGHWAY 111
Practice Address - Street 2:SUITES B & C
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-6406
Practice Address - Country:US
Practice Address - Phone:760-773-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSION HEALTHCARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health