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General NPI Number Information
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NPI Number | 1043920119
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Entity Type | Organization
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Legal Business Name | MERCY SEAT MENTAL HEALTH TREATMENT CENTER LLC
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Dates
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Enumeration Date | 11/30/2022
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 1640 2ND ST STE 105
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City | NORCO
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State | CA
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Zip | 92860-2983
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Country | US
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Telephone | 424-221-0834
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Fax | 951-407-1042
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Provider Business Mailing Address
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Address Line | 1640 2ND ST
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City | NORCO
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State | CA
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Zip | 92860-2969
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Country | US
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Telephone | 424-221-0834
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Fax |
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Authorized Official
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Title or Position | OWNER OF THE ENTITY
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Name | STELLA ALAH-TIH FONGOD
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Credential |
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Telephone | 424-221-0834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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