Healthcare Provider Details

I. General information

NPI: 1518330794
Provider Name (Legal Business Name): J LIEB HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 RIDGE AVE
STATE COLLEGE PA
16803-3442
US

IV. Provider business mailing address

533 RIDGE AVE
STATE COLLEGE PA
16803-3442
US

V. Phone/Fax

Practice location:
  • Phone: 814-883-9949
  • Fax:
Mailing address:
  • Phone: 814-883-9949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JASON LIEB
Title or Position: OWNER
Credential: M.S.
Phone: 814-883-9949