Provider Demographics
NPI:1154440113
Name:MCKAY SHARED LIVING SERVICES
Entity Type:Organization
Organization Name:MCKAY SHARED LIVING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:F
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-232-0975
Mailing Address - Street 1:PO BOX 411
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04461
Mailing Address - Country:US
Mailing Address - Phone:207-827-4710
Mailing Address - Fax:866-477-1018
Practice Address - Street 1:240 MAIN STREET
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:ME
Practice Address - Zip Code:04468
Practice Address - Country:US
Practice Address - Phone:207-827-4710
Practice Address - Fax:866-477-1018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME198880000Medicaid