Provider Demographics
NPI:1710232269
Name:MCCOY CARE INC.
Entity Type:Organization
Organization Name:MCCOY CARE INC.
Other - Org Name:MCCOY ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-551-4322
Mailing Address - Street 1:120 E 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2869
Mailing Address - Country:US
Mailing Address - Phone:352-383-9770
Mailing Address - Fax:352-735-1545
Practice Address - Street 1:120 E 20TH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2869
Practice Address - Country:US
Practice Address - Phone:352-383-9770
Practice Address - Fax:352-735-1545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9069261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000972000Medicaid