1841202504 NPI number — PRESBYTERIAN HOMES IN THE PRESBYTERY OF LAKE ERIE

Table of content: (NPI 1841202504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841202504 NPI number — PRESBYTERIAN HOMES IN THE PRESBYTERY OF LAKE ERIE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESBYTERIAN HOMES IN THE PRESBYTERY OF LAKE ERIE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OAKWOOD HEIGHTS
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841202504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1225 SCHOOL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16505-2691
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-314-1718
Provider Business Mailing Address Fax Number:
814-314-1749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 VO TECH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OIL CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16301-3502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-676-8686
Provider Business Practice Location Address Fax Number:
814-677-9349
Provider Enumeration Date:
08/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SEIB
Authorized Official First Name:
GARY
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
VICE PRESIDENT / CFO
Authorized Official Telephone Number:
814-314-1718

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  424402 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0694 . This is a "HIGHMARK/KHPW" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".