Healthcare Provider Details

I. General information

NPI: 1740318369
Provider Name (Legal Business Name): MARE ISLAND HOME HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 TENNESSEE ST
VALLEJO CA
94590-4654
US

IV. Provider business mailing address

1555 TENNESSEE ST
VALLEJO CA
94590-4654
US

V. Phone/Fax

Practice location:
  • Phone: 707-557-6800
  • Fax: 707-557-6801
Mailing address:
  • Phone: 707-557-6800
  • Fax: 707-557-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EUNICE DOMINGO BEJAR-LEE
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 707-557-6800