Provider Demographics
NPI:1689231029
Name:LECOM AT VILLAGE SQUARE, LLC
Entity Type:Organization
Organization Name:LECOM AT VILLAGE SQUARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF LTC OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:BABIAK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MHSA
Authorized Official - Phone:814-452-3271
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:814-452-3271
Mailing Address - Fax:
Practice Address - Street 1:149 W 22ND ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2804
Practice Address - Country:US
Practice Address - Phone:814-452-3271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility