Mackenzie Manor LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

101538 Issued in TX

Legal business name

MACKENZIE MANOR LLC

Practice address

5450 Maple Vis
San Antonio, TX 78247-4603

Phone

(210) 387-3390

NPI assigned

May 17, 2007

Last updated

Aug 13, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. John Charles Marcus Jr., LVN

Title

Manager

Phone

(210) 387-3390

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218585600000",
    "number": "1396952180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5450 MAPLE VIS",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782474603",
            "telephone_number": "210-387-3390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5450 MAPLE VIS",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782474603",
            "telephone_number": "210-387-3390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACKENZIE MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2008-08-13",
        "status": "A",
        "authorized_official_last_name": "MARCUS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "210-387-3390",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "LVN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TX",
            "license": "101538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "F50015226",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Christina Mack, LVN
• Lawrence C. Mack Jr., LPC
• Lynell Marie Mack
• Nia Ajae Mack
• Sarah Katherine Mackay, COTA
• Mylene Marie Mackey, LPC
• William N Mackey, LCSW
• Patricia Michaela Mackin, MD
• Andrew Ian Mackinnon, M.D.
• Allison Rose Macmaster, LPC

• Assisted Living Facility in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Assisted Living Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.