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Provider Demographic Information - ODP PROVIDER ONE

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PROVIDER DEMOGRAPHIC INFORMATION Supporting line for group header


Name:	ODP PROVIDER ONE
Address:	Physical Address Line 1 gfrsdg, PA 17011
Phone:	(634) 354-5454
Web Site:	N/A

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PROVIDER CERTIFICATION INFORMATION Supporting line for group header

Click here to view Provider Certification Information

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PROVIDER'S PARENT/ REGIONAL OFFICE Supporting line for group header


Type:	Corporate Office
Name:	Test LE Name
Address:	ELMLEY AVE MECHANICSBURG, PA 17050-2938
Phone:	(717) 222-3333

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PROVIDER SERVICES AND RATES Supporting line for group header


County : Allegheny
\|Service Name / Level	\|Rate

Comm 9+ Indiv Home (6400 Inelig)	Not Set
Comm Resid Rehab 9+ Indiv Home (5310 Inelig)	Not Set
Life Sharing-1 person-Elig-NG 1 > 30 Hrs	Not Set
Life Sharing-1 person-Elig-NG 1-by relative	Not Set
Life Sharing-1 person-Elig-NG 2	Not Set
Life Sharing-1 person-Elig-NG 2-by relative	Not Set
Life Sharing-1 person-Elig-NG 3-by relative	Not Set
Life Sharing-1 person-Elig-NG 4	Not Set
Life Sharing-1 person-Elig-NG 4-by relative	Not Set
Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set
Res Hab-2 Person-NG 4-Elig	Not Set
Res Hab-2 Person-NG 4-Elig-UA	Not Set
Res Hab-2 Person-NG 4-Elig-w/Day Supports	Not Set
Res Hab-2 Person-NG 4-Elig-w/Day Supports-UA	Not Set
Res Hab-3 Person-NG 1-Elig	Not Set
Res Hab-3 Person-NG 1-Elig-UA	Not Set
Res Hab-3 Person-NG 1-Elig-w/Day Supports	Not Set
Res Hab-3 Person-NG 1-Elig-w/Day Supports-UA	Not Set
Res Hab-3 Person-NG 2-Elig	Not Set
Res Hab-3 Person-NG 2-Elig-UA	Not Set
Respite Only Home-2 People-Lic-Day-NG 1	Not Set
Respite Only Home-2 People-Lic-Day-NG 2	Not Set
Respite Only Home-2 People-Lic-Day-NG 3	Not Set
Respite Only Home-2 People-Lic-Day-NG 4	Not Set
Respite Only Home-3 People-Lic-Day-NG 1	Not Set
Respite Only Home-3 People-Lic-Day-NG 2	Not Set
Respite Only Home-3 People-Lic-Day-NG 3	Not Set
Respite Only Home-3 People-Lic-Day-NG 4	Not Set
Respite Only Home-4 People-Lic-Day-NG 1	Not Set
Respite Only Home-4 People-Lic-Day-NG 2	Not Set
Respite Only Home-4 People-Lic-Day-NG 3	Not Set
Respite Only Home-4 People-Lic-Day-NG 4	Not Set
Supports Coordination	$11.00 - $21.32 / 15 min.

County : Armstrong/Indiana
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Beaver
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Bedford/Somerset
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Berks
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Blair
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Bradford/Sullivan
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Bucks
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Butler
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Cambria
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Cameron/Elk
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Carbon/Monroe/Pike
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Centre
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Chester
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Clarion
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Clearfield/Jefferson
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Columbia/Montour/Snyder/Union
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Crawford
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Cumberland/Perry
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Dauphin
\|Service Name / Level	\|Rate

FSS/Individual Payment-Dollar	Not Set
Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set
Respite-Base Out-of-Home 24 Hours (Level 1)-Day	Not Set
Respite-Base Out-of-Home 24 Hours (Level 2)-Day	Not Set

County : Delaware
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Erie
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Fayette
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Forest/Warren
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Franklin/Fulton
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Greene
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Huntingdon/Mifflin/Juniata
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Lackawanna/Susquehanna
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Lancaster
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Lawrence
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Lebanon
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Lehigh
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Luzerne/Wyoming
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Lycoming/Clinton
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : McKean
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Mercer
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Montgomery
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Northampton
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Northumberland
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Philadelphia
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set
Supports Coordination	$11.00 - $21.32 / 15 min.

County : Potter
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Schuylkill
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Tioga
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Venango
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Washington
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Wayne
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : Westmoreland
\|Service Name / Level	\|Rate

Child Resid 9+ Indiv Home (3800 Inelig)	Not Set
Comm 9+ Indiv Home (6400 Inelig)	Not Set
Comm Resid Rehab 9+ Indiv Home (5310 Inelig)	Not Set
Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

County : York/Adams
\|Service Name / Level	\|Rate

Nursing (1:2) LPN	Not Set
Nursing (1:2) RN	Not Set
Nursing - (1:1) LPN-15 min	Not Set
Nursing - (1:1) LPN-15 minutes	Not Set
Nursing - (1:1) RN-15 minutes	Not Set

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