Healthcare Provider Details

I. General information

NPI: 1427658798
Provider Name (Legal Business Name): MCAP BUCHANAN OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 CAROLL ST
BUCHANAN MI
49107-1738
US

IV. Provider business mailing address

809 CAROLL ST
BUCHANAN MI
49107-1738
US

V. Phone/Fax

Practice location:
  • Phone: 269-591-9323
  • Fax:
Mailing address:
  • Phone: 269-591-9323
  • Fax:

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: MARCIA CURTISS
Title or Position: REGIONAL DIRECTOR
Credential:
Phone: 269-591-9323