Provider Demographics
NPI:1871579383
Name:FAYETTE HOMECARE
Entity type:Organization
Organization Name:FAYETTE HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:HARDY
Authorized Official - Last Name:LEONE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:724-439-1610
Mailing Address - Street 1:110 YOUNGSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LEMONT FURNACE
Mailing Address - State:PA
Mailing Address - Zip Code:15456-1020
Mailing Address - Country:US
Mailing Address - Phone:724-439-1610
Mailing Address - Fax:724-430-6892
Practice Address - Street 1:110 YOUNGSTOWN RD
Practice Address - Street 2:
Practice Address - City:LEMONT FURNACE
Practice Address - State:PA
Practice Address - Zip Code:15456-1020
Practice Address - Country:US
Practice Address - Phone:724-439-1610
Practice Address - Fax:724-430-6892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA397134251E00000X
PA391556251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA397134Medicare ID - Type UnspecifiedMEDICARE PROVIDER
PA391556Medicare ID - Type UnspecifiedHOSPICE PROVIDER