Provider Demographics
NPI:1588936389
Name:MCLEAN'S HEALTHCARE LLC
Entity type:Organization
Organization Name:MCLEAN'S HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:301-395-0188
Mailing Address - Street 1:1468 GESNA DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1647
Mailing Address - Country:US
Mailing Address - Phone:301-395-0188
Mailing Address - Fax:
Practice Address - Street 1:1468 GESNA DR
Practice Address - Street 2:SUITE B
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1647
Practice Address - Country:US
Practice Address - Phone:301-395-0188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR131588261Q00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center