MEDICARE: DEVOTEDCAREATHOMELLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063126456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVOTEDCAREATHOMELLC

Provider Business Mailing Address
First Line	:	4145 DAVISON AVE
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16504-2521
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4145 DAVISON AVE
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16504-2521
Country	:	US
Telephone Number	:	814-844-4783
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LATREASE OATIS
Credential	:	LPN
Telephone Number	:	814-844-4783

Provider Enumeration Date	:	01/10/2023
Last Update Date	:	01/10/2023

Similar Medicare Providers

1235843970 — DEVOTED CARE AT HOME LLC
Practice Location Address:

4145 DAVISON AVE
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1477432888 — JACQUELYN REDENZ LPC, NCC
Practice Location Address:

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1437211307 — GARY MICHAEL RITTEN MD
Practice Location Address:

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Directions to “DEVOTEDCAREATHOMELLC ” Practice Location

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