Provider Demographics
NPI:1023017787
Name:ERWINES PRIVATE DUTY HEALTH CARE, INC.
Entity Type:Organization
Organization Name:ERWINES PRIVATE DUTY HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ERWINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-288-1013
Mailing Address - Street 1:250 PIERCE ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5149
Mailing Address - Country:US
Mailing Address - Phone:570-288-3833
Mailing Address - Fax:570-283-3722
Practice Address - Street 1:270 PIERCE ST
Practice Address - Street 2:SUITE 208
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5141
Practice Address - Country:US
Practice Address - Phone:570-288-3833
Practice Address - Fax:570-283-3722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101136409001Medicaid
PA3707-32OtherLUZERNE COUNTY AAA