Provider Demographics
NPI:1902948235
Name:MONES JOHN MOHSENI
Entity Type:Organization
Organization Name:MONES JOHN MOHSENI
Other - Org Name:MEEKLAND ICF DDH
Other - Org Type:Other Name
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MONES
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MOHSENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-909-4476
Mailing Address - Street 1:20774 MEEKLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541
Mailing Address - Country:US
Mailing Address - Phone:510-909-4476
Mailing Address - Fax:510-538-7892
Practice Address - Street 1:20774 MEEKLAND AVENUE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541
Practice Address - Country:US
Practice Address - Phone:510-909-4476
Practice Address - Fax:510-538-7892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55G190OtherMEEKLAND ICF-DDH