Provider Demographics
NPI:1083940209
Name:MAC RESIDENTIAL SERVICES, INC.
Entity Type:Organization
Organization Name:MAC RESIDENTIAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-547-4692
Mailing Address - Street 1:10 MOUNT VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:ME
Mailing Address - Zip Code:04330-2302
Mailing Address - Country:US
Mailing Address - Phone:207-547-4692
Mailing Address - Fax:207-547-2149
Practice Address - Street 1:60 DUNBAR HILL RD
Practice Address - Street 2:
Practice Address - City:EMBDEN LAKE
Practice Address - State:ME
Practice Address - Zip Code:04958
Practice Address - Country:US
Practice Address - Phone:207-566-5766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS 3417320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities