Healthcare Provider Details

I. General information

NPI: 1750945952
Provider Name (Legal Business Name): LANDIS HCBS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E OREGON RD
LITITZ PA
17543-9205
US

IV. Provider business mailing address

1001 E OREGON RD
LITITZ PA
17543-9205
US

V. Phone/Fax

Practice location:
  • Phone: 717-581-3920
  • Fax:
Mailing address:
  • Phone: 717-581-3920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier103581316-0001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: EVON L BERGEY
Title or Position: EXECUTIVE DIRECTOR, LANDIS HCBS
Credential: LCSW
Phone: 717-874-8260