MEDICARE: HICKORY CREEK HOME CARE, LLC

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	253Z00000X	In Home Supportive Care 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	:	1558929984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HICKORY CREEK HOME CARE, LLC

Provider Business Mailing Address
First Line	:	315 2ND AVE STE 311
Second Line	:
City	:	WARREN
State	:	PA
Zip	:	16365-2433
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 2ND AVE STE 311
Second Line	:
City	:	WARREN
State	:	PA
Zip	:	16365-2433
Country	:	US
Telephone Number	:	814-406-9921
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	JILL COREY
Credential	:
Telephone Number	:	814-866-2919

Provider Enumeration Date	:	05/31/2019
Last Update Date	:	05/31/2019

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