Provider Demographics
NPI:1184626491
Name:MCNRC, LP
Entity type:Organization
Organization Name:MCNRC, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:KLINGERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-784-0111
Mailing Address - Street 1:2616 LOCUST GAP HWY
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:PA
Mailing Address - Zip Code:17851-1881
Mailing Address - Country:US
Mailing Address - Phone:570-339-2501
Mailing Address - Fax:570-339-0430
Practice Address - Street 1:2616 LOCUST GAP HWY
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-1881
Practice Address - Country:US
Practice Address - Phone:570-339-2501
Practice Address - Fax:570-339-0430
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCNRC LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-01
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA137802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA395589Medicare Oscar/Certification