# MONES JOHN MOHSENI AND MINA MOHSENI

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Liberty Homes Hathaway ICF/DD-H
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659545069
- **Authorized official:** MR. MONES JOHN MOHSENI (LICENSEE/ADMINISTRATOR)
- **Authorized official phone:** (510) 278-8908

## Contact information

- **Practice address:** 19834 HATHAWAY AVE, HAYWARD, CA 94541-2313
- **Practice address phone:** (510) 278-8908
- **Practice address fax:** (510) 278-8908
- **Mailing address:** 19834 HATHAWAY AVE, HAYWARD, CA 94541-2313
- **Mailing address phone:** (510) 278-8908
- **Mailing address fax:** (510) 278-8908

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | 550000119 | CA | Yes |

## Other

- **Enumeration date:** 04/16/2008
- **Last updated:** 06/18/2008