NPIMap

Organization Active NPI

Mikkadesh Mental Healthcare LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Puyallup, WA
National Provider Identifier
1063120020
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
MIKKADESH MENTAL HEALTHCARE LLC
Doing business as
Mikkadesh Mental Healthcare LLC
Practice address
12923 Emerald Ridge Blvd E
Puyallup, WA 98374-8403
Phone
(801) 649-7584
NPI assigned
Nov 9, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Veronica Abeh ForchuNPI 1427724988
Title
President/Administrator
Phone
(801) 649-7584

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

12923 Emerald Ridge Blvd E
Puyallup, WA 98374-8403

Mailing address

12923 Emerald Ridge Blvd E
Puyallup, WA 98374-8403
Phone (801) 649-7584

Other names 1

  • Mikkadesh Mental Healthcare LLC Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL mikkadeshmentalhc.org Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240430001590 WA Part B Supplier - Clinic/Group Practice 2961888383 Receives reassigned benefits from 4 practitioners
Practice locations: Puyallup, WA

National Provider Directory

National Provider Directory

Locations

2713 E Main
Puyallup, WA 98372

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733788800000",
    "number": "1063120020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12923 EMERALD RIDGE BLVD E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983748403",
            "telephone_number": "801-649-7584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12923 EMERALD RIDGE BLVD E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983748403",
            "telephone_number": "801-649-7584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIKKADESH MENTAL HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-09",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A",
        "authorized_official_last_name": "FORCHU",
        "authorized_official_first_name": "VERONICA",
        "authorized_official_middle_name": "ABEH",
        "authorized_official_title_or_position": "PRESIDENT/ADMINISTRATOR",
        "authorized_official_telephone_number": "801-649-7584"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "mikkadeshmentalhc.org",
            "affiliation": "N",
            "endpointDescription": "Mikkadesh Mental Healthcare",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "12923 Emerald Ridge Blvd E",
            "city": "Puyallup",
            "state": "WA",
            "country_code": "US",
            "postal_code": "983748403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mikkadesh Mental Healthcare LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.