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General NPI Number Information
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NPI Number | 1053659086
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Entity Type | Organization
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Legal Business Name | MCR CARE INC.
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Dates
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Enumeration Date | 01/25/2013
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 2223 GOLDEN DEW CIR
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City | SAN JOSE
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State | CA
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Zip | 95121-1441
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Country | US
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Telephone | 408-205-5975
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Fax |
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Provider Business Mailing Address
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Address Line | 2223 GOLDEN DEW CIRCLE
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City | SAN JOSE
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State | CA
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Zip | 95121
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Country | US
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Telephone | 408-205-5975
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. OSCAR ILUSORIO
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Credential |
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Telephone | 408-205-5975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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