Provider Demographics
NPI:1326283086
Name:MULLICAN SCC LLC
Entity Type:Organization
Organization Name:MULLICAN SCC LLC
Other - Org Name:MULLICAN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-436-4343
Mailing Address - Street 1:105 N MAIN
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:TX
Mailing Address - Zip Code:75479-2133
Mailing Address - Country:US
Mailing Address - Phone:903-367-3320
Mailing Address - Fax:903-367-3322
Practice Address - Street 1:105 N MAIN
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:TX
Practice Address - Zip Code:75479-2133
Practice Address - Country:US
Practice Address - Phone:903-367-3320
Practice Address - Fax:903-367-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001016926Medicaid
TX675439Medicare Oscar/Certification
6300970001Medicare NSC