Provider Demographics
NPI:1336375542
Name:ERIE INDEPENDENCE HOUSE, INC.
Entity Type:Organization
Organization Name:ERIE INDEPENDENCE HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:BEHNKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-461-9188
Mailing Address - Street 1:1611 PEACH ST
Mailing Address - Street 2:SUITE 145
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-2109
Mailing Address - Country:US
Mailing Address - Phone:814-461-9188
Mailing Address - Fax:814-461-0232
Practice Address - Street 1:1611 PEACH ST
Practice Address - Street 2:SUITE 145
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-2109
Practice Address - Country:US
Practice Address - Phone:814-461-9188
Practice Address - Fax:814-461-0232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007694800003Medicaid