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General NPI Number Information
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NPI Number | 1588272884
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Entity Type | Organization
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Legal Business Name | MILLCREEK MANOR
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Dates
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Enumeration Date | 07/22/2020
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 5535 PEACH ST
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City | ERIE
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State | PA
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Zip | 16509-2603
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Country | US
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Telephone | 814-868-2496
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Fax | 814-868-2581
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Provider Business Mailing Address
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Address Line | 5535 PEACH ST
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City | ERIE
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State | PA
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Zip | 16509-2603
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Country | US
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Telephone | 814-868-2496
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Fax | 814-868-2581
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Authorized Official
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Title or Position | CFO
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Name | JOSHUA A BEERBOWER
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Credential |
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Telephone | 814-488-4825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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