Basic Information
Provider Information | |||||||||
NPI: | 1720020399 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MCKERLEY HEALTH CARE CENTERS, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | LAUREL CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 101 E STATE ST | ||||||||
Address2: |   | ||||||||
City: | KENNETT SQUARE | ||||||||
State: | PA | ||||||||
PostalCode: | 193483109 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6109254436 | ||||||||
FaxNumber: | 6109254351 | ||||||||
Practice Location | |||||||||
Address1: | 480 DONALD ST | ||||||||
Address2: |   | ||||||||
City: | BEDFORD | ||||||||
State: | NH | ||||||||
PostalCode: | 031105945 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6036274147 | ||||||||
FaxNumber: | 6036276294 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/11/2006 | ||||||||
LastUpdateDate: | 06/21/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WILKINSON | ||||||||
AuthorizedOfficialFirstName: | MARCELLA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CORPORATE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 6109254045 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 02292 | NH | Y |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
ID Information
ID | Type | State | Issuer | Description | 904460 | 01 |   | HARVARD PILGRIM | OTHER | 1098913 | 01 |   | AETNA-HMO | OTHER | 30-5086 | 01 |   | ANTHEM | OTHER | 36762 | 01 |   | CIGNA - NH - VENDOR # | OTHER | 44001427 | 05 | NH |   | MEDICAID | 59490 | 01 |   | CIGNA - NH | OTHER | 889916 | 01 |   | MVP HEALTH PLAN | OTHER |