Healthcare Provider Details

I. General information

NPI: 1770567984
Provider Name (Legal Business Name): MARK ONE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 RICHLAND AVENUE
CERES CA
95381-1129
US

IV. Provider business mailing address

1711 RICHLAND AVENUE
CERES CA
95381-1129
US

V. Phone/Fax

Practice location:
  • Phone: 209-537-4581
  • Fax: 209-537-0035
Mailing address:
  • Phone: 209-537-4581
  • Fax: 209-537-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030000195
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. MANEESH BANSAL
Title or Position: CEO
Credential: M.D.
Phone: 562-924-9618