Provider Demographics
NPI:1104099191
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:RN, 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:814-459-1858
Practice Address - Street 1:1647 SASSAFRAS ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-1858
Practice Address - Country:US
Practice Address - Phone:814-877-6121
Practice Address - Fax:814-877-6297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA006305164W00000X, 251E00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007788280007Medicaid
1379OtherHIGHMARK BC BS