Provider Demographics
NPI:1740318369
Name:MARE ISLAND HOME HEALTH INC.
Entity type:Organization
Organization Name:MARE ISLAND HOME HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:DOMINGO
Authorized Official - Last Name:BEJAR-LEE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:707-557-6800
Mailing Address - Street 1:1555 TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4654
Mailing Address - Country:US
Mailing Address - Phone:707-557-6800
Mailing Address - Fax:707-557-6801
Practice Address - Street 1:1555 TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4654
Practice Address - Country:US
Practice Address - Phone:707-557-6800
Practice Address - Fax:707-557-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA027512OtherBUSINESS LICENSE
CA466916OtherJOINT COMMISSION
CA550000592OtherCDPH STATE LICENSE
CA027512OtherBUSINESS LICENSE
CA1740318369OtherNPI
CA466916OtherJOINT COMMISSION