Provider Demographics
NPI:1598544413
Name:MCP STUART LODGE OPCO LLC
Entity Type:Organization
Organization Name:MCP STUART LODGE OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-443-8329
Mailing Address - Street 1:12377 MERIT DR STE 500
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2343
Mailing Address - Country:US
Mailing Address - Phone:214-443-8300
Mailing Address - Fax:
Practice Address - Street 1:1301 SE PALM BEACH RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4012
Practice Address - Country:US
Practice Address - Phone:772-837-5889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility