Provider Demographics
NPI:1760251144
Name:MEKENI
Entity Type:Organization
Organization Name:MEKENI
Other - Org Name:WOUND CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALGOYEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-688-2507
Mailing Address - Street 1:6282 CYPRESS SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5198
Mailing Address - Country:US
Mailing Address - Phone:702-688-2507
Mailing Address - Fax:
Practice Address - Street 1:5625 LOSEE RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-2523
Practice Address - Country:US
Practice Address - Phone:702-790-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty