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General NPI Number Information
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NPI Number | 1790935229
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Entity Type | Organization
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Legal Business Name | MRC, LLC
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Dates
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Enumeration Date | 09/20/2008
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Last Update Date | 08/07/2013
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Provider Practice Location Address
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Address Line | 6429 DEMPSTER ST
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City | MORTON GROVE
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State | IL
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Zip | 60053-2604
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Country | US
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Telephone | 847-581-1400
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Fax | 847-581-1402
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Provider Business Mailing Address
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Address Line | 6429 DEMPSTER ST
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City | MORTON GROVE
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State | IL
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Zip | 60053-2604
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Country | US
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Telephone | 847-581-1400
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Fax | 847-581-1402
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. FARHAN SIDDIQUE
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Credential |
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Telephone | 847-581-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1010960
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License Number State | IL
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