MEDICARE: MACKENZIE MANOR LLC

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	310400000X	Assisted Living Facility	101538	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396952180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MACKENZIE MANOR LLC

Provider Business Mailing Address
First Line	:	5450 MAPLE VIS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-4603
Country	:	US
Telephone Number	:	210-387-3390
Fax Number	:

Provider Business Practice Location Address
First Line	:	5450 MAPLE VIS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-4603
Country	:	US
Telephone Number	:	210-387-3390
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. JOHN CHARLES MARCUS JR.
Credential	:	LVN
Telephone Number	:	210-387-3390

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/13/2008

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1215686001 — CHARLES YOUNG JR. LAT
Practice Location Address:

5406 MAPLE VIS
SAN ANTONIO, TX
78247-4603

Practice Phone: 210-607-0305
Practice Fax:

1972723328 — MISS HEATHER ELISE BRINICH-LANGLOIS LCSW
Practice Location Address:

4603 MIDNIGHT WOODS ST
SAN ANTONIO, TX
78249-1817

Practice Phone: 210-800-1711
Practice Fax:

1336489764 — MR. ANTONIO D RAMIREZ PH.D., LPSC
Practice Location Address:

4603 MANITOU
SAN ANTONIO, TX
78228-1835

Practice Phone: 210-416-8004
Practice Fax: 210-433-2778

1184104119 — MARISSA PUENTE
Practice Location Address:

4603 FRINGETREE WOODS ST
SAN ANTONIO, TX
78249-1807

Practice Phone: 210-334-4270
Practice Fax:

1477261410 — MONICA HILDEBRAND LPC
Practice Location Address:

4603 ROCK ELM WOODS
SAN ANTONIO, TX
78249-1482

Practice Phone: 972-742-2555
Practice Fax:

Directions to “MACKENZIE MANOR LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.