Healthcare Provider Details

I. General information

NPI: 1285545301
Provider Name (Legal Business Name): MACK ASSET MANAGEMENT GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1164 NADENE DR
MARYSVILLE CA
95901-3522
US

IV. Provider business mailing address

1652 GLENMORE DR
FAIRFIELD CA
94533-5169
US

V. Phone/Fax

Practice location:
  • Phone: 707-908-7636
  • Fax:
Mailing address:
  • Phone: 209-922-2161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TIANA MACK
Title or Position: DIRECTOR
Credential:
Phone: 707-908-7636