Healthcare Provider Details

I. General information

NPI: 1487748307
Provider Name (Legal Business Name): FAYETTE HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 YOUNGSTOWN ROAD
LEMONT FURNACE PA
15456
US

IV. Provider business mailing address

110 YOUNGSTOWN ROAD
LEMONT FURNACE PA
15456
US

V. Phone/Fax

Practice location:
  • Phone: 724-430-6828
  • Fax: 724-430-6892
Mailing address:
  • Phone: 724-430-6828
  • Fax: 724-430-6892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number713405
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number155699
License Number StatePA

VIII. Authorized Official

Name: MRS. VICKIE LEONE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 724-430-6828