Provider Demographics
NPI:1326921487
Name:CLINICAL PRACTICE OF LECOM INSTITUTE FOR SUCCESSFUL LIVING
Entity type:Organization
Organization Name:CLINICAL PRACTICE OF LECOM INSTITUTE FOR SUCCESSFUL LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-602-7783
Mailing Address - Street 1:41 W GORE RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-3621
Mailing Address - Country:US
Mailing Address - Phone:814-864-4867
Mailing Address - Fax:
Practice Address - Street 1:41 W GORE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-3621
Practice Address - Country:US
Practice Address - Phone:814-864-4867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLCREEK MANOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine