Provider Demographics
NPI:1972148435
Name:MKG ENTERPRISES CORP.
Entity Type:Organization
Organization Name:MKG ENTERPRISES CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARSHAWN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:GOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-588-4340
Mailing Address - Street 1:4974 N FRESNO ST STE 627
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-0317
Mailing Address - Country:US
Mailing Address - Phone:559-412-7248
Mailing Address - Fax:609-756-3766
Practice Address - Street 1:4021 N FRESNO ST STE 107
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4030
Practice Address - Country:US
Practice Address - Phone:559-412-7248
Practice Address - Fax:609-756-3766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No332U00000XSuppliersHome Delivered Meals
No347E00000XTransportation ServicesTransportation Broker