Provider Demographics
NPI:1508865627
Name:PRESBYTERIAN HOMES IN THE PRESBYTERY OF LAKE ERIE
Entity Type:Organization
Organization Name:PRESBYTERIAN HOMES IN THE PRESBYTERY OF LAKE ERIE
Other - Org Name:ELMWOOD GARDENS
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT / CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SEIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-314-1718
Mailing Address - Street 1:1225 SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2691
Mailing Address - Country:US
Mailing Address - Phone:814-314-1718
Mailing Address - Fax:814-314-1749
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA680202314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0660OtherHIGHMARK/KHPW
PA1007538560006Medicaid
PA1007538560006Medicaid