Healthcare Provider Details

I. General information

NPI: 1003710328
Provider Name (Legal Business Name): LEBANON HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

958 NARROWS DR
LEBANON PA
17046-8701
US

IV. Provider business mailing address

958 NARROWS DR
LEBANON PA
17046-8701
US

V. Phone/Fax

Practice location:
  • Phone: 717-675-7162
  • Fax:
Mailing address:
  • Phone: 717-675-7162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAMES OJO
Title or Position: ADMINISTRATOR
Credential:
Phone: 717-675-7162