Provider Demographics
NPI:1073396636
Name:LECOM AT ELMWOOD GARDENS LLC
Entity Type:Organization
Organization Name:LECOM AT ELMWOOD GARDENS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-881-5234
Mailing Address - Street 1:5535 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-2603
Mailing Address - Country:US
Mailing Address - Phone:814-881-5234
Mailing Address - Fax:814-871-4545
Practice Address - Street 1:2628 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1421
Practice Address - Country:US
Practice Address - Phone:814-864-4802
Practice Address - Fax:814-864-7044
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLCREEK MANOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility