Healthcare Provider Details

I. General information

NPI: 1922799550
Provider Name (Legal Business Name): MCC OF MUNCIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N MORRISON RD
MUNCIE IN
47304-5338
US

IV. Provider business mailing address

1600 N MORRISON RD
MUNCIE IN
47304-5338
US

V. Phone/Fax

Practice location:
  • Phone: 765-587-2714
  • Fax: 765-216-1040
Mailing address:
  • Phone: 765-587-2714
  • Fax: 765-216-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA BUTTERFIELD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 765-587-2714