Organization
CLINICAL PRACTICE OF LECOM INSTITUTE FOR SUCCESSFUL LIVING
Active
Parent organization
MILLCREEK MANOR
Other names
LECOM Institute for Successful Living
Organization subpart
Yes
Provider details
NPI number
Legal business name
MILLCREEK MANOR
Authorized official
JAMES Y LIN DO (PRESIDENT)
(814) 602-7783
Entity
Organization
Contact information
Practice address
5401 PEACH ST STE 3400, ERIE, PA 16509-2601
(814) 868-2200
Mailing address
5401 PEACH ST STE 3400, ERIE, PA 16509-2601
(814) 868-2200
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
213E00000X
Podiatrist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
01/22/2024
Last updated
01/26/2026
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