Provider Demographics
NPI:1679252118
Name:MILLCREEK MANOR
Entity Type:Organization
Organization Name:MILLCREEK MANOR
Other - Org Name:CLINICAL PRACTICE OF LECOM INSTITUTE FOR SUCCESSFUL LIVING
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOPEL
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 1:5401 PEACH ST STE 3400
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2601
Practice Address - Country:US
Practice Address - Phone:814-868-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLCREEK MANOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-12
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty