Provider Demographics
NPI:1982879110
Name:FAYETTE HOME CARE
Entity Type:Organization
Organization Name:FAYETTE HOME CARE
Other - Org Name:FAYETTE HOME CARE AND HOSPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-430-6828
Mailing Address - Street 1:110 YOUNGSTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:LEMONT FURNACE
Mailing Address - State:PA
Mailing Address - Zip Code:15456
Mailing Address - Country:US
Mailing Address - Phone:724-430-6828
Mailing Address - Fax:724-430-6892
Practice Address - Street 1:110 YOUNGSTOWN ROAD
Practice Address - Street 2:
Practice Address - City:LEMONT FURNACE
Practice Address - State:PA
Practice Address - Zip Code:15456
Practice Address - Country:US
Practice Address - Phone:724-430-6828
Practice Address - Fax:724-430-6892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA155699251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000021420005Medicaid
PA391556AMedicare Oscar/Certification