MEDICARE: SENIOR LIFE YORK, INC.

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	261QA0600X	Adult Day Care Clinic/Center	254600	PA
2	253Z00000X	In Home Supportive Care Agency	19933601	PA
3	251T00000X	PACE Provider Organization

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	H0819	OTHER	PA	MEDICARE AGREEMENT NUMBER

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	:	1356573406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR LIFE YORK, INC.

Provider Business Mailing Address
First Line	:	209 SIGMA DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15238-2826
Country	:	US
Telephone Number	:	412-963-9150
Fax Number	:	412-963-6676

Provider Business Practice Location Address
First Line	:	1460 MEMORY LANE EXT
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-9602
Country	:	US
Telephone Number	:	717-757-5433
Fax Number	:	717-751-0392

Authorized Official
Title or Position	:	DIRECTOR OF REIMBURSEMENT
Name	:	MR. HERBERT H HENNELL
Credential	:
Telephone Number	:	412-963-9150

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	09/26/2016

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Directions to “SENIOR LIFE YORK, INC. ” Practice Location

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