Provider Demographics
NPI:1699886960
Name:MCKINLEY HEALTH CARE CENTER LLC
Entity type:Organization
Organization Name:MCKINLEY HEALTH CARE CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:330-456-1014
Mailing Address - Street 1:800 MARKET AVENUE NORTH
Mailing Address - Street 2:SUITE 1560
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1083
Mailing Address - Country:US
Mailing Address - Phone:330-456-1014
Mailing Address - Fax:330-430-2177
Practice Address - Street 1:800 MARKET AVENUE NORTH
Practice Address - Street 2:SUITE 1560
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1083
Practice Address - Country:US
Practice Address - Phone:330-456-1014
Practice Address - Fax:330-430-2177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1815R310400000X
OH1815N313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2130750Medicaid
OH2130750Medicaid