Provider Demographics
NPI:1558963546
Name:MCLEAN COMMUNITY CARE, LLC
Entity Type:Organization
Organization Name:MCLEAN COMMUNITY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:810-270-9301
Mailing Address - Street 1:5830 N LAPEER RD
Mailing Address - Street 2:STE B & C
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48461-9660
Mailing Address - Country:US
Mailing Address - Phone:810-270-9301
Mailing Address - Fax:810-270-9302
Practice Address - Street 1:5830 N LAPEER RD
Practice Address - Street 2:STE B & C
Practice Address - City:NORTH BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48461-9660
Practice Address - Country:US
Practice Address - Phone:810-270-9301
Practice Address - Fax:810-270-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty