Provider Demographics
NPI:1154046324
Name:DEL NORTE MISSION POSSIBLE
Entity type:Organization
Organization Name:DEL NORTE MISSION POSSIBLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-464-3812
Mailing Address - Street 1:1765 NORTHCREST DR
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-8922
Mailing Address - Country:US
Mailing Address - Phone:707-464-3812
Mailing Address - Fax:
Practice Address - Street 1:1100 H ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-3422
Practice Address - Country:US
Practice Address - Phone:707-954-7319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management