Provider Demographics
NPI:1942607593
Name:MCCREADY MANOR, INC
Entity Type:Organization
Organization Name:MCCREADY MANOR, INC
Other - Org Name:TELFORD TERRACE HOME HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:WHITLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-625-1400
Mailing Address - Street 1:300 STOCKER DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-4304
Mailing Address - Country:US
Mailing Address - Phone:859-625-1400
Mailing Address - Fax:859-625-1623
Practice Address - Street 1:1025 ROBERT TELFORD DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-1199
Practice Address - Country:US
Practice Address - Phone:859-626-5200
Practice Address - Fax:859-626-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health