Provider Demographics
NPI:1053659086
Name:MCR CARE INC.
Entity Type:Organization
Organization Name:MCR CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ILUSORIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-205-5975
Mailing Address - Street 1:2223 GOLDEN DEW CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121
Mailing Address - Country:US
Mailing Address - Phone:408-205-5975
Mailing Address - Fax:
Practice Address - Street 1:2223 GOLDEN DEW CIR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1441
Practice Address - Country:US
Practice Address - Phone:408-205-5975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities