Provider Demographics
NPI:1750945952
Name:LANDIS HCBS
Entity type:Organization
Organization Name:LANDIS HCBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, LANDIS HCBS
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 E OREGON RD
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-9205
Mailing Address - Country:US
Mailing Address - Phone:717-581-3920
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:717-581-3920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANDIS HCBS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103581316-0001Medicaid