Provider Demographics
NPI:1497080691
Name:SIERRA HOMEHEALTH CARE AGENCY, LLC
Entity Type:Organization
Organization Name:SIERRA HOMEHEALTH CARE AGENCY, LLC
Other - Org Name:SIERRA ALLIED HEALTH & HOMECARE AGENCY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSARAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-616-0134
Mailing Address - Street 1:401 ERFORD RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1118
Mailing Address - Country:US
Mailing Address - Phone:717-695-2165
Mailing Address - Fax:717-695-2165
Practice Address - Street 1:2337 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1816
Practice Address - Country:US
Practice Address - Phone:717-616-0134
Practice Address - Fax:717-695-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04150501251E00000X
251J00000X
PA10063601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA04150501OtherDEPART MENT OF HEALTH- MEDICARE LICENSE