Provider Demographics
NPI:1396863304
Name:MAC-CON PROPERTIES INC.
Entity Type:Organization
Organization Name:MAC-CON PROPERTIES INC.
Other - Org Name:COUNTRY LANE HOMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:LANGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-360-3815
Mailing Address - Street 1:1022 POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:EAST GULL LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3091
Mailing Address - Country:US
Mailing Address - Phone:218-825-0071
Mailing Address - Fax:
Practice Address - Street 1:1022 POPLAR DR
Practice Address - Street 2:
Practice Address - City:EAST GULL LAKE
Practice Address - State:MN
Practice Address - Zip Code:56401-3091
Practice Address - Country:US
Practice Address - Phone:218-825-0071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1045322-1-AFC302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization