NPIMap

Organization Active NPI

Millcreek Manor

Doing business as LECOM Home Care

  • In Home Supportive Care Agency
  • Erie, PA
National Provider Identifier
1699306449
Registry record updated Jan 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Legal business name
MILLCREEK MANOR
Doing business as
LECOM Home Care
Practice address
3910 Schaper Ave
Erie, PA 16508-3346
Phone
(814) 453-5072
Fax
(814) 452-1578
NPI assigned
Jan 30, 2020
Last updated
Jan 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 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
In Home Supportive Care Agency 253Z00000X Primary

Addresses

Primary practice location

3910 Schaper Ave
Erie, PA 16508-3346

Mailing address

5535 Peach St
Erie, PA 16509-2603
Phone (814) 453-5072

Other identifiers 1

IdentifierTypeStateIssuer
0012079290005MedicaidPA

Other names 1

  • LECOM Home Care Doing business as

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.

Locations

3910 Schaper Ave
Erie, PA 16508
Phone (814) 453-5072

NPI Registry JSON

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

{
    "created_epoch": "1580342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580342400000",
    "number": "1699306449",
    "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": "814-453-5072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3910 SCHAPER AVE",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165083346",
            "telephone_number": "814-453-5072",
            "fax_number": "814-452-1578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLCREEK MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-30",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "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": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012079290005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LECOM Home Care",
            "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 Jan 30, 2020; 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.