Provider Demographics
NPI:1851396022
Name:LIFE CARE HOME SERVICES OF NORTHWESTERN PENNSYLVANIA LLP
Entity Type:Organization
Organization Name:LIFE CARE HOME SERVICES OF NORTHWESTERN PENNSYLVANIA LLP
Other - Org Name:GREAT LAKES HOME HEALTHCARE SERVICES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:814-877-6121
Mailing Address - Street 1:PO BOX 641396
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15264-1396
Mailing Address - Country:US
Mailing Address - Phone:814-877-6121
Mailing Address - Fax:814-459-1858
Practice Address - Street 1:1700 PEACH ST
Practice Address - Street 2:STE 104
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-2134
Practice Address - Country:US
Practice Address - Phone:814-877-6121
Practice Address - Fax:814-453-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3000008117332B00000X, 332BX2000X
OH22656332B00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
540010053Medicare PIN
0208290001Medicare NSC