Provider Demographics
NPI:1215152400
Name:ELDERSERVE OF LANCASTER COUNTY, INC.
Entity type:Organization
Organization Name:ELDERSERVE OF LANCASTER COUNTY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-207-0755
Mailing Address - Street 1:255 BUTLER AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6308
Mailing Address - Country:US
Mailing Address - Phone:717-207-0755
Mailing Address - Fax:
Practice Address - Street 1:255 BUTLER AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6308
Practice Address - Country:US
Practice Address - Phone:717-207-0755
Practice Address - Fax:717-207-0758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1553353OtherGATEWAY HEALTH PLAN
PA1015865470001Medicaid
PA87238OtherMENTAL HLTH,MENTAL RETARD