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General NPI Number Information
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NPI Number | 1689489718
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Entity Type | Organization
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Legal Business Name | CLINICAL PRACTICE OF LECOM INSTITUTE FOR SUCCESSFUL LIVING
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 16954 CONNEAUT LAKE RD
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City | MEADVILLE
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State | PA
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Zip | 16335-3738
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Country | US
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Telephone | 814-844-2858
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Fax |
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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 | 814-844-2858
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES LIN
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Credential |
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Telephone | 814-602-7783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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