Provider Demographics
NPI:1912347584
Name:MGM HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:MGM HOME HEALTHCARE LLC
Other - Org Name:COMFORCARE SENIOR SERVICES - CENTRAL CONTRA COSTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDAROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-429-8320
Mailing Address - Street 1:1630 CONTRA COSTA BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3085
Mailing Address - Country:US
Mailing Address - Phone:925-429-8320
Mailing Address - Fax:
Practice Address - Street 1:1630 CONTRA COSTA BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3085
Practice Address - Country:US
Practice Address - Phone:925-429-8320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care