Provider Demographics
NPI:1649276742
Name:SAINT MARY'S HOME OF ERIE
Entity type:Organization
Organization Name:SAINT MARY'S HOME OF ERIE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:URBAN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:814-836-5305
Mailing Address - Street 1:4855 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-1213
Mailing Address - Country:US
Mailing Address - Phone:814-836-5300
Mailing Address - Fax:814-451-1394
Practice Address - Street 1:4855 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-1213
Practice Address - Country:US
Practice Address - Phone:814-836-5300
Practice Address - Fax:814-451-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA15440201314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007457470003Medicaid
PA1007457470003Medicaid