Provider Demographics
NPI:1932643350
Name:MARKELL & MARQUELL ENTERPRISES, LLC
Entity Type:Organization
Organization Name:MARKELL & MARQUELL ENTERPRISES, LLC
Other - Org Name:PATHWAY HOMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-972-6235
Mailing Address - Street 1:PO BOX 901
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93581-0901
Mailing Address - Country:US
Mailing Address - Phone:661-972-6235
Mailing Address - Fax:
Practice Address - Street 1:15923 SAN MARCO PL
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93314-6650
Practice Address - Country:US
Practice Address - Phone:661-972-6235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA157206784320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA320800000XOtherSTATE OF CALIFORNIA