Provider Demographics
NPI:1134784879
Name:SCOTT MACH ENTERPRISES
Entity type:Organization
Organization Name:SCOTT MACH ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:MACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-309-7383
Mailing Address - Street 1:23235 CAVANAUGH ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630
Mailing Address - Country:US
Mailing Address - Phone:949-716-1516
Mailing Address - Fax:
Practice Address - Street 1:23235 CAVANAUGH ROAD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630
Practice Address - Country:US
Practice Address - Phone:949-716-1516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility