Provider Demographics
NPI:1942562327
Name:MG CARE, INC.
Entity Type:Organization
Organization Name:MG CARE, INC.
Other - Org Name:SYNERGY HOMECARE OF DUPAGE COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-517-0068
Mailing Address - Street 1:799 ROOSEVELT RD
Mailing Address - Street 2:BUILDING 4 SUITE 105
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5908
Mailing Address - Country:US
Mailing Address - Phone:630-517-0068
Mailing Address - Fax:630-517-0069
Practice Address - Street 1:799 ROOSEVELT RD
Practice Address - Street 2:BUILDING 4 SUITE 105
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5908
Practice Address - Country:US
Practice Address - Phone:630-517-0068
Practice Address - Fax:630-517-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILHF100045253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILHF100045OtherILLINOIS DEPARTMENT OF PUBLIC HEALTH