Basic Information
| Provider Information | |||||||||
| NPI: | 1720229560 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LOCK HAVEN HOME CARE SERVICES LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CENTRAL PENNSYLVANIA HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 208 E CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | LOCK HAVEN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 177452025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154657488 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 208 E CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | LOCK HAVEN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 177452025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154657488 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2009 | ||||||||
| LastUpdateDate: | 10/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | HOLTSFORD | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6154657466 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | PENDING | PA | Y | Agencies | Hospice Care, Community Based |
No ID Information.