MEDICARE: MID PENN HOMECARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1164916995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID PENN HOMECARE LLC

Provider Business Mailing Address
First Line	:	1514 COMMERCE AVE STE 203
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17015-9161
Country	:	US
Telephone Number	:	717-243-5473
Fax Number	:	717-620-3406

Provider Business Practice Location Address
First Line	:	1514 COMMERCE AVE STE 203
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17015-9161
Country	:	US
Telephone Number	:	717-243-5473
Fax Number	:	717-620-3406

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE LISK
Credential	:
Telephone Number	:	717-243-5473

Provider Enumeration Date	:	06/15/2018
Last Update Date	:	06/15/2018

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