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General NPI Number Information
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NPI Number | 1780018812
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Entity Type | Organization
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Legal Business Name | ACHIEVEMENT CENTER OF LECOM HEALTH
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Dates
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Enumeration Date | 08/26/2013
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 4950 W 23RD ST SUITE 1
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City | ERIE
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State | PA
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Zip | 16506-5802
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Country | US
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Telephone | 814-616-0509
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Fax |
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Provider Business Mailing Address
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Address Line | 4950 W 23RD ST SUITE 1
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City | ERIE
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State | PA
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Zip | 16506-5802
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Country | US
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Telephone | 814-616-0509
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Fax |
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | CHRISTINE RICHARDS
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Credential |
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Telephone | 814-616-0509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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