Provider Demographics
NPI:1487655809
Name:WRC PENNSYLVANIA MEMORIAL HOME
Entity Type:Organization
Organization Name:WRC PENNSYLVANIA MEMORIAL HOME
Other - Org Name:MCKINLEY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHMADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-849-1205
Mailing Address - Street 1:985 ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-7213
Mailing Address - Country:US
Mailing Address - Phone:814-849-1205
Mailing Address - Fax:814-849-7426
Practice Address - Street 1:133 LAURELBROOKE DR
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-2653
Practice Address - Country:US
Practice Address - Phone:814-849-3615
Practice Address - Fax:814-849-4913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA421402314000000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007552300003Medicaid
PA0558OtherBLUE CROSS SKILLED NURSIN
PA395550Medicare Oscar/Certification