Provider Demographics
NPI:1043440258
Name:COMMUNITY RESOURCES FOR INDEPENDENCE INC
Entity Type:Organization
Organization Name:COMMUNITY RESOURCES FOR INDEPENDENCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PUSHCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-838-7222
Mailing Address - Street 1:3410 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3649
Mailing Address - Country:US
Mailing Address - Phone:814-838-7222
Mailing Address - Fax:
Practice Address - Street 1:3410 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3649
Practice Address - Country:US
Practice Address - Phone:814-838-7222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100002483Medicaid