Healthcare Provider Details

I. General information

NPI: 1053659086
Provider Name (Legal Business Name): MCR CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 GOLDEN DEW CIR
SAN JOSE CA
95121-1441
US

IV. Provider business mailing address

2223 GOLDEN DEW CIRCLE
SAN JOSE CA
95121
US

V. Phone/Fax

Practice location:
  • Phone: 408-205-5975
  • Fax:
Mailing address:
  • Phone: 408-205-5975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. OSCAR ILUSORIO
Title or Position: VICE PRESIDENT
Credential:
Phone: 408-205-5975