Healthcare Provider Details

I. General information

NPI: 1982263877
Provider Name (Legal Business Name): MESSIAH LIFEWAYS COMMUNITY SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 WALNUT BOTTOM RD
CARLISLE PA
17015-9146
US

IV. Provider business mailing address

100 MOUNT ALLEN DR
MECHANICSBURG PA
17055-6171
US

V. Phone/Fax

Practice location:
  • Phone: 717-697-4666
  • Fax:
Mailing address:
  • Phone: 717-697-4666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1027311970005
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1027311970002
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerIDR/MHMR

VIII. Authorized Official

Name: TRACY BIESECKER
Title or Position: CFO
Credential:
Phone: 717-591-7228