Provider Demographics
NPI:1720185929
Name:MECCA HOME HEALTH SERVICES GROUP INC
Entity Type:Organization
Organization Name:MECCA HOME HEALTH SERVICES GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LIBERTY
Authorized Official - Middle Name:MENDOZA
Authorized Official - Last Name:DACUDAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-732-1935
Mailing Address - Street 1:246 W COLLEGE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723
Mailing Address - Country:US
Mailing Address - Phone:626-732-1935
Mailing Address - Fax:626-732-2835
Practice Address - Street 1:246 W COLLEGE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723
Practice Address - Country:US
Practice Address - Phone:626-732-1935
Practice Address - Fax:626-732-2835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058241Medicare ID - Type Unspecified