Healthcare Provider Details

I. General information

NPI: 1194566653
Provider Name (Legal Business Name): HEALTHY HOUSE WITHIN A MATCH COALITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W 18TH ST STE 101
MERCED CA
95340-4831
US

IV. Provider business mailing address

301 W 18TH ST STE 101
MERCED CA
95340-4831
US

V. Phone/Fax

Practice location:
  • Phone: 209-724-0102
  • Fax: 209-724-0153
Mailing address:
  • Phone: 209-724-0102
  • Fax: 209-724-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CANDICE OLINE ADAM-MEDEFIND
Title or Position: EXECUTIVE DIRECTOR209658
Credential: J.D
Phone: 209-658-1945