Healthcare Provider Details

I. General information

NPI: 1336375542
Provider Name (Legal Business Name): ERIE INDEPENDENCE HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 PEACH ST SUITE 145
ERIE PA
16501-2109
US

IV. Provider business mailing address

1611 PEACH ST SUITE 145
ERIE PA
16501-2109
US

V. Phone/Fax

Practice location:
  • Phone: 814-461-9188
  • Fax: 814-461-0232
Mailing address:
  • Phone: 814-461-9188
  • Fax: 814-461-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PAUL F BEHNKEN
Title or Position: CONTROLLER
Credential:
Phone: 814-461-9188