Provider Demographics
NPI:1013497601
Name:LANDIS HCBS
Entity Type:Organization
Organization Name:LANDIS HCBS
Other - Org Name:LANDIS AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EVON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERGEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:717-874-8260
Mailing Address - Street 1:1001 EAST OREGON RD.
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543
Mailing Address - Country:US
Mailing Address - Phone:717-874-8260
Mailing Address - Fax:
Practice Address - Street 1:1001 E OREGON RD
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-9205
Practice Address - Country:US
Practice Address - Phone:717-874-8260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANDIS HCBS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-14
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA13493601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA13493601OtherPA DOH LICENSE