Healthcare Provider Details

I. General information

NPI: 1245676345
Provider Name (Legal Business Name): MILLCREEK COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 03/07/2020
Certification Date: 03/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 PEACH ST
ERIE PA
16509-2603
US

IV. Provider business mailing address

5515 PEACH ST
ERIE PA
16509-2603
US

V. Phone/Fax

Practice location:
  • Phone: 814-864-4031
  • Fax: 814-868-7770
Mailing address:
  • Phone: 814-864-4031
  • Fax: 814-868-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number570101
License Number StatePA

VIII. Authorized Official

Name: MICHAEL HELLER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 814-868-7758