Provider Demographics
NPI:1275294951
Name:MCC OF SUGAR GROVE, LLC
Entity Type:Organization
Organization Name:MCC OF SUGAR GROVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIRTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-777-6933
Mailing Address - Street 1:175 OLDE HALF DAY RD STE 292
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3063
Mailing Address - Country:US
Mailing Address - Phone:847-777-6933
Mailing Address - Fax:847-777-6934
Practice Address - Street 1:58 W PARK AVE
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-2247
Practice Address - Country:US
Practice Address - Phone:847-777-6933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility