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Organization

LIFE-NORTHWESTERN PENNSYLVANIA

Active
Other names
Lutheran Home for the Aged
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MARK J. GUSEK (CEO)
(814) 456-5433
Entity
Organization

Contact information

Practice address
149 W 22ND ST, ERIE, PA 16502-2804
(814) 452-3271
(814) 456-9232
Mailing address
100 STATE ST STE 200, ERIE, PA 16507-1454
(814) 456-5433
(814) 454-2500

Taxonomy

Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1007767250005
PA
Enumeration date
09/07/2007
Last updated
11/16/2020
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