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General NPI Number Information
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NPI Number | 1750201653
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Entity Type | Organization
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Legal Business Name | MCAP FENNVILLE OPCO LLC
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Dates
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Enumeration Date | 07/20/2026
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Last Update Date | 07/20/2026
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Provider Practice Location Address
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Address Line | 2464 55TH ST
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City | FENNVILLE
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State | MI
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Zip | 49408-8448
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Country | US
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Telephone | 269-561-4663
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Fax | 269-561-2440
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Provider Business Mailing Address
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Address Line | 915 E HIGH ST STE 600
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-4820
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Country | US
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Telephone | 434-220-1055
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Fax | 434-322-3211
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | EARL PARKER
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Credential |
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Telephone | 434-220-1055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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