Healthcare Provider Details

I. General information

NPI: 1801870019
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: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 W MAIN STREET
TURLOCK CA
95380-4645
US

IV. Provider business mailing address

812 W MAIN STREET
TURLOCK CA
95380-4645
US

V. Phone/Fax

Practice location:
  • Phone: 209-667-2828
  • Fax: 209-667-4683
Mailing address:
  • Phone: 209-667-2828
  • Fax: 209-667-4683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030000263
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