Healthcare Provider Details

I. General information

NPI: 1780673863
Provider Name (Legal Business Name): MCCREADY FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HALL HWY
CRISFIELD MD
21817-1237
US

IV. Provider business mailing address

201 HALL HWY
CRISFIELD MD
21817-1237
US

V. Phone/Fax

Practice location:
  • Phone: 410-968-1200
  • Fax: 410-968-1025
Mailing address:
  • Phone: 410-968-1200
  • Fax: 410-968-1025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number19003
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number19003
License Number StateMD

VIII. Authorized Official

Name: MR. FRANK COLLINS JR.
Title or Position: PATIENT ACCOUNTS MANAGER
Credential:
Phone: 410-968-1200