NPIMap

Organization Active NPI

Millcreek Manor

  • Clinical Medical Laboratory
  • Erie, PA
National Provider Identifier
1346848298
Registry record updated Oct 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
MILLCREEK MANOR
Practice address
5535 Peach St
Erie, PA 16509-2603
Phone
(814) 868-2496
Fax
(814) 868-2581
NPI assigned
Oct 13, 2020
Last updated
Oct 13, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
MILLCREEK HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 13, 2020

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

Authorized official

Name
Erica Demauri
Title
Controller
Phone
(814) 868-2496

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

5535 Peach St
Erie, PA 16509-2603

Mailing address

5535 Peach St
Erie, PA 16509-2603
Phone (814) 868-2496

Other names 1

  • Millcreek Manor COVID Lab Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080715000810 PA Part A Provider - Skilled Nursing Facility 1456424084 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Erie, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346848298. Details of each certification follow.

Skilled nursing facility certification: CCN 396072

Legal name
MILLCREEK MANOR
Doing business as
LECOM HEALTH
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 24, 2000
Last certification
Jan 24, 2025
Beds
144
Ownership / control type
Nonprofit Corporation
Multi-facility organization
LECOM
Organization structure
CorporationProprietary
Incorporated
Nov 27, 1989 in PA
Enrollment address
5535 Peach St
Erie, PA 16509-2603
Nursing home name
MILLCREEK MANOR
Affiliated entity
LECOM SENIOR LIVING

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Nursing home

Medicare Care Compare
Listed as
Millcreek ManorCCN 396072 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jul 24, 2000
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
144139.0 residents per day on average
Chain
Lecom Senior Living5 facilities in the chain
Penalties (3 years)
1Fines totaling $100,240

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0889023Millcreek Manor5535 Peach Street, Erie, PA 16509Certificate of waiverJul 17, 2028

National Provider Directory

National Provider Directory
Tax ID family
Millcreek Manor Pharmacy12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Member organizations 8

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Joshua Alan Beerbower Individual Operational/Managerial Control Nov 3, 2023
Adp of the SNF Nov 3, 2023
James Yi Lin Individual Corporate DirectorPresident Jul 1, 2024
Trustee of the SNF Jul 1, 2024
Adp of the SNF Apr 28, 2025
Individual Adp of the SNF Jun 28, 2024
Individual Adp of the SNF Apr 28, 2025
Jaime Lynn Babiak Individual Operational/Managerial Control Nov 21, 2022
Millcreek Health System Organization, Erie, PA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Nov 8, 2003 100%
Adp of the SNF Nov 8, 2003
Steven Inman Individual Corporate DirectorVP Fiscal Affairs Sep 1, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • James Y Lin, DO
    • Geriatric Medicine (Internal Medicine) Physician
    • Erie, PA
    • NPI 1164599155

    Adp of the SNF, Corporate Director, Trustee of the SNF

    CMS ownership

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602547200000",
    "number": "1346848298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5535 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092603",
            "telephone_number": "814-868-2496",
            "fax_number": "814-868-2581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5535 PEACH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165092603",
            "telephone_number": "814-868-2496",
            "fax_number": "814-868-2581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLCREEK MANOR",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILLCREEK HEALTH SYSTEM",
        "enumeration_date": "2020-10-13",
        "last_updated": "2020-10-13",
        "certification_date": "2020-07-22",
        "status": "A",
        "authorized_official_last_name": "DEMAURI",
        "authorized_official_first_name": "ERICA",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "814-868-2496"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Millcreek Manor COVID Lab",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.