Provider Demographics
NPI:1043920119
Name:MERCY SEAT MENTAL HEALTH TREATMENT CENTER LLC
Entity type:Organization
Organization Name:MERCY SEAT MENTAL HEALTH TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF THE ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:ALAH-TIH
Authorized Official - Last Name:FONGOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-221-0834
Mailing Address - Street 1:1640 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-2969
Mailing Address - Country:US
Mailing Address - Phone:424-221-0834
Mailing Address - Fax:
Practice Address - Street 1:1640 2ND ST STE 105
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-2983
Practice Address - Country:US
Practice Address - Phone:424-221-0834
Practice Address - Fax:951-407-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty