Provider Demographics
NPI:1871246777
Name:MEMORIALCARE MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:MEMORIALCARE MEDICAL FOUNDATION
Other - Org Name:MEMORIALCARE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MCMF - SENIOR MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-241-3499
Mailing Address - Street 1:230 S. MAIN ST, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-541-0101
Mailing Address - Fax:714-541-0450
Practice Address - Street 1:230 S. MAIN ST, SUITE 100
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-541-0101
Practice Address - Fax:714-541-0450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-31
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site