Provider Demographics
NPI:1215392824
Name:LECOM AT PRESQUE ISLE INC
Entity Type:Organization
Organization Name:LECOM AT PRESQUE ISLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:OLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-868-7767
Mailing Address - Street 1:4114 SCHAPER AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-3350
Mailing Address - Country:US
Mailing Address - Phone:814-868-0831
Mailing Address - Fax:814-868-7778
Practice Address - Street 1:4114 SCHAPER AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-3350
Practice Address - Country:US
Practice Address - Phone:814-868-0831
Practice Address - Fax:814-868-7778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LECOM HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-24
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA53042314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA395404Medicare PIN