Provider Demographics
NPI:1851332332
Name:ST MARY'S HOME OF ERIE
Entity Type:Organization
Organization Name:ST MARY'S HOME OF ERIE
Other - Org Name:SAINT MARY'S EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SR MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FROMKNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-451-1309
Mailing Address - Street 1:607 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-2813
Mailing Address - Country:US
Mailing Address - Phone:814-459-0621
Mailing Address - Fax:814-451-1394
Practice Address - Street 1:607 E 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-2813
Practice Address - Country:US
Practice Address - Phone:814-459-0621
Practice Address - Fax:814-451-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA010700261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care