Healthcare Provider Details

I. General information

NPI: 1770595415
Provider Name (Legal Business Name): PRESBYTERIAN HOMES IN THE PRESBYTERY OF LAKE ERIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6351 W LAKE RD
ERIE PA
16505-2676
US

IV. Provider business mailing address

1225 SCHOOL RD
ERIE PA
16505-2691
US

V. Phone/Fax

Practice location:
  • Phone: 814-838-9191
  • Fax: 814-838-2901
Mailing address:
  • Phone: 814-314-1718
  • Fax: 814-314-1749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number075602
License Number StatePA

VIII. Authorized Official

Name: MR. GARY C SEIB
Title or Position: VICE PRESIDENT / CFO
Credential:
Phone: 814-314-1718