Healthcare Provider Details

I. General information

NPI: 1851332332
Provider Name (Legal Business Name): ST MARY'S HOME OF ERIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 E 26TH ST
ERIE PA
16504-2813
US

IV. Provider business mailing address

607 E 26TH ST
ERIE PA
16504-2813
US

V. Phone/Fax

Practice location:
  • Phone: 814-459-0621
  • Fax: 814-451-1394
Mailing address:
  • Phone: 814-459-0621
  • Fax: 814-451-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number010700
License Number StatePA

VIII. Authorized Official

Name: SR MARY FROMKNECHT
Title or Position: ADMINISTRATOR
Credential:
Phone: 814-451-1309