NPIMap

Organization Active NPI

Life Care Home Services of Northwestern Pennsylvania LLP

  • Registered Nurse
  • Erie, PA
National Provider Identifier
1104099191
Registry record updated Mar 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
006305 Issued in PA
Legal business name
LIFE CARE HOME SERVICES OF NORTHWESTERN PENNSYLVANIA LLP
Practice address
1647 Sassafras St
Erie, PA 16502-1858
Phone
(814) 877-6121
Fax
(814) 877-6297
NPI assigned
Apr 10, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2011

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

Authorized official

Name
Mrs. Kathy L Dubowski, RN, MSN
Title
President
Phone
(814) 877-6121

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163W00000X 006305 PA Primary
Licensed Practical NurseGroup: 193200000X MULTI-SPECIALTY GROUP 164W00000X 006305 PA
Home Health Agency 251E00000X 006305 PA

Addresses

Primary practice location

1647 Sassafras St
Erie, PA 16502-1858

Mailing address

1647 Sassafras St
Erie, PA 16502-1858
Phone (814) 877-6121

Other identifiers 2

IdentifierTypeStateIssuer
1007788280007MedicaidPA
1379OtherHIGHMARK BC BS

Other names 1

  • Great Lakes Home Healthcare Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Life Care Home Services3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1647 Sassafras St
Erie, PA 16502
Phone (814) 877-6121

NPI Registry JSON

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

{
    "created_epoch": "1207785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300320000000",
    "number": "1104099191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1647 SASSAFRAS ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165021858",
            "telephone_number": "814-877-6121",
            "fax_number": "814-459-1858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1647 SASSAFRAS ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165021858",
            "telephone_number": "814-877-6121",
            "fax_number": "814-877-6297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CARE HOME SERVICES OF NORTHWESTERN PENNSYLVANIA LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-10",
        "last_updated": "2011-03-17",
        "status": "A",
        "authorized_official_last_name": "DUBOWSKI",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-877-6121",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, MSN"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "006305",
            "primary": true
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Licensed Practical Nurse",
            "state": "PA",
            "license": "006305",
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "PA",
            "license": "006305",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007788280007",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BC BS",
            "identifier": "1379",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Home Healthcare Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 17, 2011; 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.