MEDICARE: MCR CARE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility
2	313M00000X	Nursing Facility/Intermediate Care Facility

General Provider Information

NPI Number	:	1053659086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCR CARE INC.

Provider Business Mailing Address
First Line	:	2223 GOLDEN DEW CIRCLE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121
Country	:	US
Telephone Number	:	408-205-5975
Fax Number	:

Provider Business Practice Location Address
First Line	:	2223 GOLDEN DEW CIR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1441
Country	:	US
Telephone Number	:	408-205-5975
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. OSCAR ILUSORIO
Credential	:
Telephone Number	:	408-205-5975

Provider Enumeration Date	:	01/25/2013
Last Update Date	:	01/25/2013

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