MEDICARE: MCKINLEY GROUP HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility	1055	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437392628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCKINLEY GROUP HOME

Provider Business Mailing Address
First Line	:	PO BOX 7917
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71306-0917
Country	:	US
Telephone Number	:	348-445-1551
Fax Number	:	318-445-1242

Provider Business Practice Location Address
First Line	:	6500 MASONIC DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-2321
Country	:	US
Telephone Number	:	318-443-7724
Fax Number	:	318-443-7729

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CHRISTINA BONNETTE BOLTON
Credential	:
Telephone Number	:	318-445-1551

Provider Enumeration Date	:	04/17/2009
Last Update Date	:	04/17/2009

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Directions to “MCKINLEY GROUP HOME ” Practice Location

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