Provider Demographics
NPI:1447553763
Name:LIFE CARE HOME SERVICES OF NORTHWESTERN PENNSYLVANIA LLP
Entity type:Organization
Organization Name:LIFE CARE HOME SERVICES OF NORTHWESTERN PENNSYLVANIA LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUBOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:814-877-6121
Mailing Address - Street 1:1647 SASSAFRAS ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-1858
Mailing Address - Country:US
Mailing Address - Phone:814-877-6121
Mailing Address - Fax:814-877-3027
Practice Address - Street 1:1700 PEACH ST
Practice Address - Street 2:STE 104
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-2134
Practice Address - Country:US
Practice Address - Phone:814-877-6121
Practice Address - Fax:814-877-3027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP414351L261QI0500X
NY029138261QI0500X
OHNTP021052100261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy