Provider Demographics
NPI:1194566653
Name:HEALTHY HOUSE WITHIN A MATCH COALITION
Entity type:Organization
Organization Name:HEALTHY HOUSE WITHIN A MATCH COALITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR209658
Authorized Official - Prefix:MS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:OLINE
Authorized Official - Last Name:ADAM-MEDEFIND
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:209-658-1945
Mailing Address - Street 1:301 W 18TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-4831
Mailing Address - Country:US
Mailing Address - Phone:209-724-0102
Mailing Address - Fax:209-724-0153
Practice Address - Street 1:301 W 18TH ST STE 101
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-4831
Practice Address - Country:US
Practice Address - Phone:209-724-0102
Practice Address - Fax:209-724-0153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No171R00000XOther Service ProvidersInterpreterGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty