Healthcare Provider Details

I. General information

NPI: 1750201653
Provider Name (Legal Business Name): MCAP FENNVILLE OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2464 55TH ST
FENNVILLE MI
49408-8448
US

IV. Provider business mailing address

915 E HIGH ST STE 600
CHARLOTTESVILLE VA
22902-4820
US

V. Phone/Fax

Practice location:
  • Phone: 269-561-4663
  • Fax: 269-561-2440
Mailing address:
  • Phone: 434-220-1055
  • Fax: 434-322-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: EARL PARKER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 434-220-1055