NPIMap

Organization Active NPI

Millcreek Manor

Doing business as LECOM Senior Living Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Erie, PA
National Provider Identifier
1528646403
Registry record updated Mar 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
MILLCREEK MANOR
Doing business as
LECOM Senior Living Center
Practice address
5535 Peach St
Erie, PA 16509-2603
Phone
(814) 868-7395
Fax
(814) 868-2581
NPI assigned
Mar 31, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2021

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
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

5535 Peach St
Erie, PA 16509-2603

Mailing address

5535 Peach St
Erie, PA 16509-2603
Phone (814) 868-7395

Other names 2

  • LECOM Senior Living Center Doing business as
  • LECOM Heath Dialysis Other name

National Provider Directory

National Provider Directory
Tax ID family
Millcreek Manor12 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.

NPI Registry JSON

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

{
    "created_epoch": "1617148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617148800000",
    "number": "1528646403",
    "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": "814-868-7395",
            "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": "814-868-7395",
            "fax_number": "814-868-2581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLCREEK MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-31",
        "last_updated": "2021-03-31",
        "certification_date": "2020-10-13",
        "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": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LECOM Senior Living Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LECOM Heath Dialysis",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 31, 2021; 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.