Provider Demographics
NPI:1790935229
Name:MRC, LLC
Entity Type:Organization
Organization Name:MRC, LLC
Other - Org Name:3 ANGELS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FARHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-581-1400
Mailing Address - Street 1:6429 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2604
Mailing Address - Country:US
Mailing Address - Phone:847-581-1400
Mailing Address - Fax:847-581-1402
Practice Address - Street 1:6429 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2604
Practice Address - Country:US
Practice Address - Phone:847-581-1400
Practice Address - Fax:847-581-1402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MRC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-20
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010960251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health