Healthcare Provider Details

I. General information

NPI: 1205987864
Provider Name (Legal Business Name): MOURI MANAGEMENT GROUP INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 CROYDON AVE
SAN JOSE CA
95118-3522
US

IV. Provider business mailing address

3220 FLINTDALE DRIVE
SAN JOSE CA
95148-1231
US

V. Phone/Fax

Practice location:
  • Phone: 408-267-2109
  • Fax: 408-531-9020
Mailing address:
  • Phone: 408-531-9126
  • Fax: 408-531-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberLTC60949F
License Number StateCA

VIII. Authorized Official

Name: NOEL DE JESUS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 408-531-9126