Provider Demographics
NPI:1689384539
Name:460 MRC LLC
Entity Type:Organization
Organization Name:460 MRC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANKUR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-432-0675
Mailing Address - Street 1:460 NEWELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-9247
Mailing Address - Country:US
Mailing Address - Phone:352-365-6011
Mailing Address - Fax:352-365-9923
Practice Address - Street 1:460 NEWELL HILL RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-9247
Practice Address - Country:US
Practice Address - Phone:352-365-6011
Practice Address - Fax:352-365-9923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility