Healthcare Provider Details

I. General information

NPI: 1124181953
Provider Name (Legal Business Name): ACHIEVEMENT CENTER OF LECOM HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 W 23RD ST SUITE 1
ERIE PA
16506
US

IV. Provider business mailing address

4950 W 23RD ST STE 1
ERIE PA
16506-5802
US

V. Phone/Fax

Practice location:
  • Phone: 814-459-2755
  • Fax: 814-456-4873
Mailing address:
  • Phone: 814-459-2755
  • Fax: 814-456-4873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE RICHARDS
Title or Position: SUPERVISOR OR CLIENT BILLING
Credential:
Phone: 814-616-0509