NPIMap

Organization Active NPI

Community Resources for Independence Inc

  • In Home Supportive Care Agency
  • Erie, PA
National Provider Identifier
1043440258
Registry record updated Jul 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Legal business name
COMMUNITY RESOURCES FOR INDEPENDENCE INC
Practice address
3410 W 12TH St
Erie, PA 16505-3649
Phone
(814) 838-7222
NPI assigned
Jul 22, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Martin M Pushchak
Title
Controller
Phone
(814) 838-7222

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X
In Home Supportive Care Agency 253Z00000X Primary

Addresses

Primary practice location

3410 W 12TH St
Erie, PA 16505-3649

Mailing address

3410 W 12TH St
Erie, PA 16505-3649
Phone (814) 838-7222

Other identifiers 1

IdentifierTypeStateIssuer
100002483MedicaidPA

National Provider Directory

National Provider Directory

Locations

3410 W 12th St
Erie, PA 16505
Phone (814) 838-7222

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1248220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248220800000",
    "number": "1043440258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3410 W 12TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165053649",
            "telephone_number": "814-838-7222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3410 W 12TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165053649",
            "telephone_number": "814-838-7222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY RESOURCES FOR INDEPENDENCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-22",
        "last_updated": "2009-07-22",
        "status": "A",
        "authorized_official_last_name": "PUSHCHAK",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "814-838-7222",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002483",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.