Provider Demographics
NPI:1619774213
Name:MMM GROUP LLC
Entity type:Organization
Organization Name:MMM GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARCELINO
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRELES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-594-6311
Mailing Address - Street 1:5411 BROOK MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2438
Mailing Address - Country:US
Mailing Address - Phone:209-594-6311
Mailing Address - Fax:
Practice Address - Street 1:3639 MILL SPRINGS DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-3227
Practice Address - Country:US
Practice Address - Phone:209-594-6311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MMM GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-28
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility