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Organization

MACKENZIE MANOR LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JOHN CHARLES MARCUS JR. LVN (MANAGER)
(210) 387-3390
Entity
Organization

Contact information

Practice address
5450 MAPLE VIS, SAN ANTONIO, TX 78247-4603
(210) 387-3390
Mailing address
5450 MAPLE VIS, SAN ANTONIO, TX 78247-4603
(210) 387-3390

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
101538
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
F50015226
TX
Enumeration date
05/17/2007
Last updated
08/13/2008
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