Healthcare Provider Details

I. General information

NPI: 1386274199
Provider Name (Legal Business Name): MILLCREEK MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 SCHAPER AVE
ERIE PA
16508-3346
US

IV. Provider business mailing address

5535 PEACH ST
ERIE PA
16509-2603
US

V. Phone/Fax

Practice location:
  • Phone: 814-453-5072
  • Fax: 814-452-1578
Mailing address:
  • Phone: 814-868-2496
  • Fax: 814-868-2581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERICA DEMAURI
Title or Position: CONTROLLER
Credential:
Phone: 814-868-2496