Provider Demographics
NPI:1104416544
Name:MISSION MERCED INCORPORATED
Entity type:Organization
Organization Name:MISSION MERCED INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-480-3899
Mailing Address - Street 1:PO BOX 3319
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-1319
Mailing Address - Country:US
Mailing Address - Phone:209-722-9269
Mailing Address - Fax:
Practice Address - Street 1:900 N ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-5951
Practice Address - Country:US
Practice Address - Phone:209-722-9269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCED RESCUE MISSION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-20
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging