Healthcare Provider Details

I. General information

NPI: 1720229560
Provider Name (Legal Business Name): LOCK HAVEN HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E CHURCH ST
LOCK HAVEN PA
17745-2025
US

IV. Provider business mailing address

208 E CHURCH ST
LOCK HAVEN PA
17745-2025
US

V. Phone/Fax

Practice location:
  • Phone: 615-465-7488
  • Fax:
Mailing address:
  • Phone: 615-465-7488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberPENDING
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: LAURIE HOLTSFORD
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 615-465-7466