Healthcare Provider Details

I. General information

NPI: 1538916929
Provider Name (Legal Business Name): MRA ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N JOHNSON ST
VISALIA CA
93291-4834
US

IV. Provider business mailing address

503 N JOHNSON ST
VISALIA CA
93291-4834
US

V. Phone/Fax

Practice location:
  • Phone: 559-300-4564
  • Fax:
Mailing address:
  • Phone: 559-300-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ACOSTA
Title or Position: MANAGER
Credential:
Phone: 559-300-4564