MEDICARE: LIFE CARE HOME SERVICES OF NORTHWESTERN PENNSYLVANIA LLP

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	332B00000X	Durable Medical Equipment & Medical Supplies	3000008117	PA
2	335E00000X	Prosthetic/Orthotic Supplier
3	332B00000X	Durable Medical Equipment & Medical Supplies	22656	OH
4	332BX2000X	Oxygen Equipment & Supplies (DME)	3000008117	PA

General Provider Information

NPI Number	:	1851396022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE CARE HOME SERVICES OF NORTHWESTERN PENNSYLVANIA LLP

Provider Business Mailing Address
First Line	:	PO BOX 641396
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15264-1396
Country	:	US
Telephone Number	:	814-877-6121
Fax Number	:	814-459-1858

Provider Business Practice Location Address
First Line	:	1700 PEACH ST
Second Line	:	STE 104
City	:	ERIE
State	:	PA
Zip	:	16501-2134
Country	:	US
Telephone Number	:	814-877-6121
Fax Number	:	814-453-2440

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KATHY DUBOWSKI
Credential	:	RN, MSN
Telephone Number	:	814-877-6121

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	02/01/2012

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