Healthcare Provider Details

I. General information

NPI: 1730845694
Provider Name (Legal Business Name): MRC HOSPITALITY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 CORAL BEACH CIR
CASSELBERRY FL
32707-3401
US

IV. Provider business mailing address

341 CORAL BEACH CIR
CASSELBERRY FL
32707-3401
US

V. Phone/Fax

Practice location:
  • Phone: 267-394-1621
  • Fax:
Mailing address:
  • Phone: 267-394-1621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: OMAR LUTAS
Title or Position: OWNER
Credential:
Phone: 267-394-1621