Provider Demographics
NPI:1457338295
Name:MCLEAN CARE CENTER INC.
Entity Type:Organization
Organization Name:MCLEAN CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:806-259-3566
Mailing Address - Street 1:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:TX
Mailing Address - Zip Code:79057-0780
Mailing Address - Country:US
Mailing Address - Phone:806-779-2496
Mailing Address - Fax:806-779-2515
Practice Address - Street 1:605 WEST 7TH
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:TX
Practice Address - Zip Code:79057-0780
Practice Address - Country:US
Practice Address - Phone:806-779-2496
Practice Address - Fax:806-779-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110935314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675973Medicare ID - Type Unspecified