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General NPI Number Information
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NPI Number | 1104099191
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Entity Type | Organization
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Legal Business Name | LIFE CARE HOME SERVICES OF NORTHWESTERN PENNSYLVANIA LLP
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 03/17/2011
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Provider Practice Location Address
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Address Line | 1647 SASSAFRAS ST
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City | ERIE
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State | PA
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Zip | 16502-1858
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Country | US
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Telephone | 814-877-6121
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Fax | 814-877-6297
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Provider Business Mailing Address
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Address Line | 1647 SASSAFRAS ST
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City | ERIE
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State | PA
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Zip | 16502-1858
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Country | US
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Telephone | 814-877-6121
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Fax | 814-459-1858
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. KATHY L DUBOWSKI
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Credential | RN, MSN
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Telephone | 814-877-6121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 006305
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 006305
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 006305
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License Number State | PA
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