Organization
CLINICAL PRACTICE OF LECOM INSTITUTE FOR SUCCESSFUL LIVING
Active
Parent organization
MILLCREEK MANOR
Other names
LECOM Institute for Successful Living at Meadville
Organization subpart
Yes
Provider details
NPI number
Legal business name
MILLCREEK MANOR
Authorized official
JAMES LIN (PRESIDENT)
(814) 602-7783
Entity
Organization
Contact information
Practice address
16954 CONNEAUT LAKE RD, MEADVILLE, PA 16335-3738
(814) 868-2200
Mailing address
5535 PEACH ST, ERIE, PA 16509-2603
(814) 844-2858
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Enumeration date
10/28/2024
Last updated
02/03/2025
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