Healthcare Provider Details

I. General information

NPI: 1326035973
Provider Name (Legal Business Name): MCKEAN CARE SERVICES, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 06/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17083 ROUTE 6
SMETHPORT PA
16749-4025
US

IV. Provider business mailing address

17083 ROUTE 6
SMETHPORT PA
16749-4025
US

V. Phone/Fax

Practice location:
  • Phone: 814-887-5601
  • Fax: 814-887-2085
Mailing address:
  • Phone: 814-887-5601
  • Fax: 814-887-2085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number195402
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier101226041
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1012260410001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. PETER J LICARI
Title or Position: PRESIDENT
Credential:
Phone: 215-441-7700