Provider Demographics
NPI:1083492086
Name:MACMULLEN 22 LLC
Entity Type:Organization
Organization Name:MACMULLEN 22 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:830-946-5555
Mailing Address - Street 1:763 STEEPLEBUSH
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-0165
Mailing Address - Country:US
Mailing Address - Phone:830-946-5555
Mailing Address - Fax:
Practice Address - Street 1:763 STEEPLEBUSH
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-0165
Practice Address - Country:US
Practice Address - Phone:830-946-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care