Provider Demographics
NPI:1962115857
Name:MAC LIMOUSINE SERVICE INC
Entity type:Organization
Organization Name:MAC LIMOUSINE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:DAMON
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-746-1399
Mailing Address - Street 1:347 S CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-4905
Mailing Address - Country:US
Mailing Address - Phone:773-746-1399
Mailing Address - Fax:773-626-2118
Practice Address - Street 1:347 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-4905
Practice Address - Country:US
Practice Address - Phone:773-746-1399
Practice Address - Fax:773-626-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization