Provider Demographics
NPI:1699143420
Name:MBCG, LLC
Entity type:Organization
Organization Name:MBCG, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNAE
Authorized Official - Middle Name:
Authorized Official - Last Name:RHOADES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-747-4663
Mailing Address - Street 1:14780 SW OSPREY DR STE 295
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8073
Mailing Address - Country:US
Mailing Address - Phone:503-747-4663
Mailing Address - Fax:
Practice Address - Street 1:14780 SW OSPREY DR STE 295
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-8073
Practice Address - Country:US
Practice Address - Phone:503-747-4663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2281253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care