Healthcare Provider Details

I. General information

NPI: 1497080691
Provider Name (Legal Business Name): SIERRA HOMEHEALTH CARE AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2337 N 3RD ST
HARRISBURG PA
17110-1816
US

IV. Provider business mailing address

401 ERFORD RD
CAMP HILL PA
17011-1118
US

V. Phone/Fax

Practice location:
  • Phone: 717-616-0134
  • Fax: 717-695-2165
Mailing address:
  • Phone: 717-695-2165
  • Fax: 717-695-2165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number04150501
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number10063601
License Number StatePA

VIII. Authorized Official

Name: MR. PETER MANSARAY
Title or Position: CEO
Credential:
Phone: 717-616-0134