Provider Demographics
NPI:1447561154
Name:MCMC, INC.
Entity Type:Organization
Organization Name:MCMC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MONTALVO-COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-598-1144
Mailing Address - Street 1:24 GWENDOLYN CIR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-2903
Mailing Address - Country:US
Mailing Address - Phone:919-598-1144
Mailing Address - Fax:
Practice Address - Street 1:24 GWENDOLYN CIR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-2903
Practice Address - Country:US
Practice Address - Phone:919-598-1144
Practice Address - Fax:919-598-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities