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General NPI Number Information
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NPI Number | 1083113799
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Entity Type | Organization
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Legal Business Name | GREG PURCHASE LLC
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Dates
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Enumeration Date | 02/08/2018
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 2221 PENINSULA DR STE 105
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City | ERIE
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State | PA
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Zip | 16506-2954
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Country | US
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Telephone | 814-969-3031
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Fax |
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Provider Business Mailing Address
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Address Line | 614 LINCOLN AVE
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City | ERIE
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State | PA
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Zip | 16505-5014
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Country | US
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Telephone | 814-969-3031
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. GREGORY J PURCHASE
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Credential | LCSW
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Telephone | 814-969-3031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | SW133012
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License Number State | PA
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