Healthcare Provider Details

I. General information

NPI: 1003937566
Provider Name (Legal Business Name): GREATER ERIE COMMUNITY ACTION COMMITTEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 W 9TH ST
ERIE PA
16501-1343
US

IV. Provider business mailing address

18 W 9TH ST
ERIE PA
16501-1343
US

V. Phone/Fax

Practice location:
  • Phone: 814-459-4581
  • Fax: 814-456-0161
Mailing address:
  • Phone: 814-459-4581
  • Fax: 814-456-0161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBRA MENNECKE
Title or Position: DIVISION MANAGER
Credential:
Phone: 814-459-4581