Provider Demographics
NPI:1326035973
Name:MCKEAN CARE SERVICES, LP
Entity Type:Organization
Organization Name:MCKEAN CARE SERVICES, LP
Other - Org Name:SENA KEAN MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:LICARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-441-7700
Mailing Address - Street 1:17083 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:SMETHPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16749-4025
Mailing Address - Country:US
Mailing Address - Phone:814-887-5601
Mailing Address - Fax:814-887-2085
Practice Address - Street 1:17083 ROUTE 6
Practice Address - Street 2:
Practice Address - City:SMETHPORT
Practice Address - State:PA
Practice Address - Zip Code:16749-4025
Practice Address - Country:US
Practice Address - Phone:814-887-5601
Practice Address - Fax:814-887-2085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA195402314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101226041Medicaid
PA1012260410001Medicaid
PA395775Medicare ID - Type UnspecifiedPROVIDER NUMBER
PA101226041Medicaid