NPIMap

Organization Active NPI

Life-Northwestern Pennsylvania

  • PACE Provider Organization
  • Erie, PA
National Provider Identifier
1891980355
Registry record updated Nov 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PACE Provider OrganizationTaxonomy code 251T00000X
Legal business name
LIFE-NORTHWESTERN PENNSYLVANIA
Practice address
149 W 22ND St
Erie, PA 16502-2804
Phone
(814) 452-3271
Fax
(814) 456-9232
NPI assigned
Sep 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2020

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

Authorized official

Name
Mr. Mark J. Gusek
Title
Ceo
Phone
(814) 456-5433

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PACE Provider Organization 251T00000X Primary

Addresses

Primary practice location

149 W 22ND St
Erie, PA 16502-2804

Mailing address

100 State St Ste 200
Erie, PA 16507-1454
Phone (814) 456-5433

Other identifiers 1

IdentifierTypeStateIssuer
1007767250005MedicaidPA

Other names 1

  • Lutheran Home for the Aged Other name

National Provider Directory

National Provider Directory
Tax ID family
Life-Northwestern Pennsylvania3 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

149 W 22nd St
Erie, PA 16502
Phone (814) 452-3271

NPI Registry JSON

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605484800000",
    "number": "1891980355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 STATE ST STE 200",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165071454",
            "telephone_number": "814-456-5433",
            "fax_number": "814-454-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 W 22ND ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165022804",
            "telephone_number": "814-452-3271",
            "fax_number": "814-456-9232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE-NORTHWESTERN PENNSYLVANIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-07",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A",
        "authorized_official_last_name": "GUSEK",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "814-456-5433",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007767250005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lutheran Home for the Aged",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Lutheran Home for the Aged",
            "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 Nov 16, 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.