Provider Demographics
NPI:1578552048
Name:MCCREARY HEALTH & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:MCCREARY HEALTH & REHABILITATION CENTER, LLC
Other - Org Name:MCCREARY COUNTY HEALTH & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-354-3155
Mailing Address - Street 1:U.S. 27 AND HIGHWAY 592
Mailing Address - Street 2:
Mailing Address - City:PINE KNOT
Mailing Address - State:KY
Mailing Address - Zip Code:42635-0810
Mailing Address - Country:US
Mailing Address - Phone:606-354-3155
Mailing Address - Fax:606-354-3260
Practice Address - Street 1:US 27 & STATE HIGHWAY 592
Practice Address - Street 2:
Practice Address - City:PINE KNOT
Practice Address - State:KY
Practice Address - Zip Code:42635
Practice Address - Country:US
Practice Address - Phone:606-354-3155
Practice Address - Fax:606-354-3260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100635314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY18-5211Medicare ID - Type Unspecified