Provider Demographics
NPI:1336677129
Name:MAC INCORPORATED
Entity Type:Organization
Organization Name:MAC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TINGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-742-0505
Mailing Address - Street 1:909 PROGRESS CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2324
Mailing Address - Country:US
Mailing Address - Phone:410-742-0505
Mailing Address - Fax:410-742-0525
Practice Address - Street 1:909 PROGRESS CIR STE 100
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-2324
Practice Address - Country:US
Practice Address - Phone:410-742-0505
Practice Address - Fax:410-742-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD579971600Medicaid