Provider Demographics
NPI:1083019087
Name:BRETHREN VILLAGE HOME CARE
Entity Type:Organization
Organization Name:BRETHREN VILLAGE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GERGAL
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:717-581-4279
Mailing Address - Street 1:P.O.5093
Mailing Address - Street 2:3001 LITITZ PIKE,
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17606-5093
Mailing Address - Country:US
Mailing Address - Phone:717-581-4279
Mailing Address - Fax:717-581-4407
Practice Address - Street 1:3001 LITITZ PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17606-5093
Practice Address - Country:US
Practice Address - Phone:717-581-4279
Practice Address - Fax:717-581-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA14463601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care