# ERIE INDEPENDENCE HOUSE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629108741
- **Authorized official:** DAVID G SCHLAUDECKER (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (814) 461-9188

## Contact information

- **Practice address:** 3108 ZUCK RD, ERIE, PA 16506-3161
- **Practice address phone:** (814) 833-9955
- **Practice address fax:** (814) 835-1772
- **Mailing address:** 1611 PEACH ST, SUITE 145, ERIE, PA 16501-2109
- **Mailing address phone:** (814) 461-9188
- **Mailing address fax:** (814) 461-0232

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 805640 | PA | Yes |

## Other

- **Enumeration date:** 03/07/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1007694800001 | — | PA |