Provider Demographics
NPI:1982263877
Name:MESSIAH LIFEWAYS COMMUNITY SUPPORT SERVICES
Entity Type:Organization
Organization Name:MESSIAH LIFEWAYS COMMUNITY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIESECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-591-7228
Mailing Address - Street 1:100 MOUNT ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-6171
Mailing Address - Country:US
Mailing Address - Phone:717-697-4666
Mailing Address - Fax:
Practice Address - Street 1:1155 WALNUT BOTTOM RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-9146
Practice Address - Country:US
Practice Address - Phone:717-697-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MESSIAH LIFEWAYS COMMUNITY SUPPORT SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027311970005Medicaid
PA1027311970002OtherIDR/MHMR