Provider Demographics
NPI:1831302272
Name:MEDICAL HEALING CENTER
Entity Type:Organization
Organization Name:MEDICAL HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:HERCENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-855-8119
Mailing Address - Street 1:23361 EL TORO RD STE 106
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4810
Mailing Address - Country:US
Mailing Address - Phone:949-855-8119
Mailing Address - Fax:949-855-6328
Practice Address - Street 1:23361 EL TORO RD STE 106
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4810
Practice Address - Country:US
Practice Address - Phone:949-855-8119
Practice Address - Fax:949-855-6328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5374174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty