Provider Demographics
NPI:1073038964
Name:PERRY SQUARE HOME CARE, LLC
Entity Type:Organization
Organization Name:PERRY SQUARE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:COREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-866-2919
Mailing Address - Street 1:1505 STATE STREET
Mailing Address - Street 2:3RD FLOOR SOUTH SIDE SUITE 9
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1505 STATE ST FL 3
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-2206
Practice Address - Country:US
Practice Address - Phone:814-651-0799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care