Provider Demographics
NPI:1710248935
Name:MCBEAN TRANSITIONAL CARE, LLC.
Entity Type:Organization
Organization Name:MCBEAN TRANSITIONAL CARE, LLC.
Other - Org Name:LYNTON AVENUE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MCBEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-720-4141
Mailing Address - Street 1:PO BOX 113
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-0113
Mailing Address - Country:US
Mailing Address - Phone:810-720-4141
Mailing Address - Fax:810-720-4145
Practice Address - Street 1:2065 S ELMS RD
Practice Address - Street 2:SUITE 108 BLD D
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-9796
Practice Address - Country:US
Practice Address - Phone:810-720-4141
Practice Address - Fax:810-720-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS250315962320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities