Erie Independence House, Inc.

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

805640 Issued in PA

Legal business name

ERIE INDEPENDENCE HOUSE, INC.

Practice address

3108 Zuck Rd
Erie, PA 16506-3161

Phone

(814) 833-9955

Fax

(814) 835-1772

NPI assigned

Mar 7, 2007

Organization subpart

No

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

Authorized official

Name

David G Schlaudecker

Title

Executive Director

Phone

(814) 461-9188

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 39G274

Legal name

ERIE INDEPENDENCE HOUSE

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Dec 4, 1992

Last certification

Aug 6, 2025

Beds

6

Ownership / control type

Private (non-profit)

Facility address

3108 Zuck Road
Erie, PA 16506

Tax ID family

Erie Independence House Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Erie Independence House, Inc.

  • Home Health Agency
  • Erie, PA
  • NPI 1336375542
  NPD tax ID

Locations

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629108741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 PEACH ST",
            "address_2": "SUITE 145",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165012109",
            "telephone_number": "814-461-9188",
            "fax_number": "814-461-0232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3108 ZUCK RD",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165063161",
            "telephone_number": "814-833-9955",
            "fax_number": "814-835-1772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIE INDEPENDENCE HOUSE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SCHLAUDECKER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "814-461-9188"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "PA",
            "license": "805640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007694800001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erie Heart and Lung
• Erie Homes for Children and Adults, Inc.
• Erie Horizon Healing Services
• Erie Imaging, LLC
• Erie Independence House, Inc.
• Erie Medical & Rehab Center Inc
• Erie Medical Specialty Clinic, PC
• Erie Medical Specialty Clinic, PC
• Erie Operating LLC
• Erie Ops LLC

• Nursing Facility/Intermediate Care Facility in Erie, PA
• Providers in Erie, PA by specialty
• Nursing Facility/Intermediate Care Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.