Provider Demographics
NPI:1902491871
Name:MISSION HOME HEALTH OF EAST BAY LLC
Entity Type:Organization
Organization Name:MISSION HOME HEALTH OF EAST BAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD OF DIRECTORS MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAWL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-757-2700
Mailing Address - Street 1:2385 NORTHSIDE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2702
Mailing Address - Country:US
Mailing Address - Phone:619-757-2700
Mailing Address - Fax:
Practice Address - Street 1:5976 W LAS POSITAS BLVD STE 118
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8506
Practice Address - Country:US
Practice Address - Phone:619-757-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health