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Provider Demographic Information - EAGLE VALLEY RESIDENTIAL SERVIES LLC

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PROVIDER DEMOGRAPHIC INFORMATION Supporting line for group header


Name:	EAGLE VALLEY RESIDENTIAL SERVIES LLC
Address:	PO BOX 718 MILESBURG, PA 16853-0718
Phone:	(814) 355-3417
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

No parent or regional addresses are listed for this provider.

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PROVIDER SERVICES AND RATES Supporting line for group header


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

Res Hab-1 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-1 Person-NG 1-Elig-ECS	Not Set
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports-ECS	Not Set
Res Hab-1 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-1 Person-NG 2-Elig-ECS	Not Set
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports-ECS	Not Set
Res Hab-1 Person-NG 3-Elig	$980.38 / 1 Day
Res Hab-1 Person-NG 3-Elig-ECS	Not Set
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$790.99 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports-ECS	Not Set
Res Hab-1 Person-NG 4-Elig	$1,185.86 / 1 Day
Res Hab-1 Person-NG 4-Elig-ECS	Not Set
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$871.56 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports-ECS	Not Set
Res Hab-1 Person-NG5-Elig	$1,754.51 / 1 Day
Res Hab-1 Person-NG5-Elig-ECS	Not Set
Res Hab-1 Person-NG5-Elig-w/Day Supports	$1,341.85 / 1 Day
Res Hab-1 Person-NG5-Elig-w/Day Supports-ECS	Not Set
Res Hab-2 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-2 Person-NG 1-Elig-ECS	Not Set
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports-ECS	Not Set
Res Hab-2 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-2 Person-NG 2-Elig-ECS	Not Set
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports-ECS	Not Set
Res Hab-2 Person-NG 3-Elig	$726.82 / 1 Day
Res Hab-2 Person-NG 3-Elig-ECS	Not Set
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$668.54 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports-ECS	Not Set
Res Hab-2 Person-NG 4-Elig	$869.36 / 1 Day
Res Hab-2 Person-NG 4-Elig-ECS	Not Set
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$730.86 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports-ECS	Not Set
Res Hab-2 Person-NG5-Elig	$1,312.57 / 1 Day
Res Hab-2 Person-NG5-Elig-ECS	Not Set
Res Hab-2 Person-NG5-Elig-w/Day Supports	$1,215.16 / 1 Day
Res Hab-2 Person-NG5-Elig-w/Day Supports-ECS	Not Set
Res Hab-3 Person-NG 1-Elig	$411.03 / 1 Day
Res Hab-3 Person-NG 1-Elig-ECS	Not Set
Res Hab-3 Person-NG 1-Elig-w/Day Supports	$312.16 / 1 Day
Res Hab-3 Person-NG 1-Elig-w/Day Supports-ECS	Not Set
Res Hab-3 Person-NG 2-Elig	$468.38 / 1 Day
Res Hab-3 Person-NG 2-Elig-ECS	Not Set
Res Hab-3 Person-NG 2-Elig-w/Day Supports	$361.68 / 1 Day
Res Hab-3 Person-NG 2-Elig-w/Day Supports-ECS	Not Set
Res Hab-3 Person-NG 3-Elig	$545.05 / 1 Day
Res Hab-3 Person-NG 3-Elig-ECS	Not Set
Res Hab-3 Person-NG 3-Elig-w/Day Supports	$467.35 / 1 Day
Res Hab-3 Person-NG 3-Elig-w/Day Supports-ECS	Not Set
Res Hab-3 Person-NG 4-Elig	$662.22 / 1 Day
Res Hab-3 Person-NG 4-Elig-ECS	Not Set
Res Hab-3 Person-NG 4-Elig-w/Day Supports	$513.07 / 1 Day
Res Hab-3 Person-NG 4-Elig-w/Day Supports-ECS	Not Set
Res Hab-3 Person-NG5-Elig	$1,004.32 / 1 Day
Res Hab-3 Person-NG5-Elig-ECS	Not Set
Res Hab-3 Person-NG5-Elig-w/Day Supports	$835.46 / 1 Day
Res Hab-3 Person-NG5-Elig-w/Day Supports-ECS	Not Set
Res Hab-4 Person-NG 2-Elig-w/Day Supports	$284.31 / 1 Day
Res Hab-Lic-1 Person-Inelig	$93.64 / 1 Day
Res Hab-Lic-2 Person-Inelig	$50.22 / 1 Day
Res Hab-Lic-3 Person-Inelig	$35.47 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 2	$367.82 / 1 Day
Res Hab-Lic-4 Person-Elig-NG5	$766.28 / 1 Day
Res Hab-Lic-4 Person-Inelig	$27.15 / 1 Day
Res Hab-Lic-5-8 Person-Inelig	$18.93 / 1 Day
Respit-Life Sharin-Day(Lvl4,2:1Enh)OutHome ECS LPN	Not Set
Respit-Life Sharing-Day(Lvl3,1:1 Enh)OutOfHome-LPN	Not Set
Respit-Life Sharing-Day(Lvl3,1:1Enh)OutHomeECS-LPN	Not Set
Respit-Life Sharing-Day(Lvl4,2:1 Enh)OutOfHome LPN	Not Set
Respite Base-Emerg Lic 6400 24 Hrs Lvl 2 Enh-TD U2	Not Set
Respite Base-Emerg Lic 6400 24 Hrs Lvl 2 Enh-TE U2	Not Set
Respite Base-Emerg Lic 6400 24 Hrs Lvl 3 Enh-TD U2	Not Set
Respite Base-Emerg Lic 6400 24 Hrs Lvl 3 Enh-TE U2	Not Set
Respite, Base-Emerg Licen 6400 24 Hrs Basic-U2	Not Set
Respite, Base-Emerg Licen 6400 24 Hrs Lvl 1-U2	Not Set
Respite, Base-Emerg Licen 6400 24 Hrs Lvl 2 Enh-U2	Not Set
Respite, Base-Emerg Licen 6400 24 Hrs Lvl 2-U2	Not Set
Respite, Base-Emerg Licen 6400 24 Hrs Lvl 3 Enh-U2	Not Set
Respite, Base-Emerg Licen 6400 24 Hrs Lvl 3-U2	Not Set
Respite, Non-Waiver Setting/PLF, NG 1	Not Set
Respite, Non-Waiver Setting/PLF, NG 1-ECS	Not Set
Respite, Non-Waiver Setting/PLF, NG 2	Not Set
Respite, Non-Waiver Setting/PLF, NG 2-ECS	Not Set
Respite, Non-Waiver Setting/PLF, NG 3	Not Set
Respite, Non-Waiver Setting/PLF, NG 3-ECS	Not Set
Respite, Non-Waiver Setting/PLF, NG 4	Not Set
Respite, Non-Waiver Setting/PLF, NG 4-ECS	Not Set
Respite, Non-Waiver Setting/PLF, NG5	Not Set
Respite, Non-Waiver Setting/PLF, NG5-ECS	Not Set
Respite-Base Out-of-Home 24 Hours (Basic)-Day	Not Set
Respite-Base Out-of-Home 24 Hours (Level 1)-Day	Not Set
Respite-Base Out-of-Home 24 Hours (Level 2 Enh)	Not Set
Respite-Base Out-of-Home 24 Hours (Level 2 Enh)-TD	Not Set
Respite-Base Out-of-Home 24 Hours (Level 2 Enh)-TE	Not Set
Respite-Base Out-of-Home 24 Hours (Level 2)-Day	Not Set
Respite-Base Out-of-Home 24 Hours (Level 3 Enh)	Not Set
Respite-Base Out-of-Home 24 Hours (Level 3 Enh)-TD	Not Set
Respite-Base Out-of-Home 24 Hours (Level 3 Enh)-TE	Not Set
Respite-Base Out-of-Home 24 Hours (Level 3)	Not Set
Respite-Lic-Day-1 person-NG 3	Not Set
Respite-Lic-Day-1 person-NG 3-ECS	Not Set
Respite-Lic-Day-1 person-NG 3-Emergency	Not Set
Respite-Lic-Day-1 person-NG 3-Emergency-ECS	Not Set
Respite-Lic-Day-1 person-NG 4	Not Set
Respite-Lic-Day-1 person-NG 4-ECS	Not Set
Respite-Lic-Day-1 person-NG 4-Emergency	Not Set
Respite-Lic-Day-1 person-NG 4-Emergency-ECS	Not Set
Respite-Lic-Day-1 person-NG5	Not Set
Respite-Lic-Day-1 person-NG5-ECS	Not Set
Respite-Lic-Day-1 person-NG5-Emergency	Not Set
Respite-Lic-Day-1 person-NG5-Emergency-ECS	Not Set
Respite-Lic-Day-2 person-NG 1-Emergency	Not Set
Respite-Lic-Day-2 person-NG 1-Emergency-ECS	Not Set
Respite-Lic-Day-2 person-NG 2	Not Set
Respite-Lic-Day-2 person-NG 2-ECS	Not Set
Respite-Lic-Day-2 person-NG 2-Emergency	Not Set
Respite-Lic-Day-2 person-NG 2-Emergency-ECS	Not Set
Respite-Lic-Day-2 person-NG 3	Not Set
Respite-Lic-Day-2 person-NG 3-ECS	Not Set
Respite-Lic-Day-2 person-NG 3-Emergency	Not Set
Respite-Lic-Day-2 person-NG 3-Emergency-ECS	Not Set
Respite-Lic-Day-2 person-NG 4	Not Set
Respite-Lic-Day-2 person-NG 4-ECS	Not Set
Respite-Lic-Day-2 person-NG 4-Emergency	Not Set
Respite-Lic-Day-2 person-NG 4-Emergency-ECS	Not Set
Respite-Lic-Day-2 person-NG1	Not Set
Respite-Lic-Day-2 person-NG1-ECS	Not Set
Respite-Lic-Day-2 person-NG5	Not Set
Respite-Lic-Day-2 person-NG5-ECS	Not Set
Respite-Lic-Day-2 person-NG5-Emergency	Not Set
Respite-Lic-Day-2 person-NG5-Emergency-ECS	Not Set
Respite-Lic-Day-3 person-NG 1	Not Set
Respite-Lic-Day-3 person-NG 1-ECS	Not Set
Respite-Lic-Day-3 person-NG 1-Emergency	Not Set
Respite-Lic-Day-3 person-NG 1-Emergency-ECS	Not Set
Respite-Lic-Day-3 person-NG 2	Not Set
Respite-Lic-Day-3 person-NG 2-ECS	Not Set
Respite-Lic-Day-3 person-NG 2-Emergency	Not Set
Respite-Lic-Day-3 person-NG 2-Emergency-ECS	Not Set
Respite-Lic-Day-3 person-NG 3	Not Set
Respite-Lic-Day-3 person-NG 3-ECS	Not Set
Respite-Lic-Day-3 person-NG 3-Emergency	Not Set
Respite-Lic-Day-3 person-NG 3-Emergency-ECS	Not Set
Respite-Lic-Day-3 person-NG 4	Not Set
Respite-Lic-Day-3 person-NG 4-ECS	Not Set
Respite-Lic-Day-3 person-NG 4-Emergency	Not Set
Respite-Lic-Day-3 person-NG 4-Emergency-ECS	Not Set
Respite-Lic-Day-3 person-NG5	Not Set
Respite-Lic-Day-3 person-NG5-ECS	Not Set
Respite-Lic-Day-3 person-NG5-Emergency	Not Set
Respite-Lic-Day-3 person-NG5-Emergency-ECS	Not Set
Respite-Lic-Day-4 person-NG 1	Not Set
Respite-Lic-Day-4 person-NG 1-ECS	Not Set
Respite-Lic-Day-4 person-NG 1-Emergency	Not Set
Respite-Lic-Day-4 person-NG 1-Emergency-ECS	Not Set
Respite-Lic-Day-4 person-NG 2	Not Set
Respite-Lic-Day-4 person-NG 2-ECS	Not Set
Respite-Lic-Day-4 person-NG 2-Emergency	Not Set
Respite-Lic-Day-4 person-NG 2-Emergency-ECS	Not Set
Respite-Lic-Day-4 person-NG 3	Not Set
Respite-Lic-Day-4 person-NG 3-ECS	Not Set
Respite-Lic-Day-4 person-NG 3-Emergency	Not Set
Respite-Lic-Day-4 person-NG 3-Emergency-ECS	Not Set
Respite-Lic-Day-4 person-NG 4	Not Set
Respite-Lic-Day-4 person-NG 4-ECS	Not Set
Respite-Lic-Day-4 person-NG 4-Emergency	Not Set
Respite-Lic-Day-4 person-NG 4-Emergency-ECS	Not Set
Respite-Lic-Day-4 person-NG5	Not Set
Respite-Lic-Day-4 person-NG5-ECS	Not Set
Respite-Lic-Day-4 person-NG5-Emergency	Not Set
Respite-Lic-Day-4 person-NG5-Emergency-ECS	Not Set
Respite-Life Sharing-Day (Level 2, 1:2)Out-of-Home	Not Set
Respite-Life Sharing-Day (Level 3, 1:1)Out-of-Home	Not Set
Respite-Life Sharing-Day (Level 4, 2:1)Out-of-Home	Not Set
Respite-Life Sharing-Day(L3,1:1 Enh)OutOf Home-ECS	Not Set
Respite-Life Sharing-Day(Lvl 2,1:2)Out-of-Home-ECS	Not Set
Respite-Life Sharing-Day(Lvl 3,1:1 Enh)Out-of-Home	Not Set
Respite-Life Sharing-Day(Lvl 3,1:1)Out-of-Home-ECS	Not Set
Respite-Life Sharing-Day(Lvl 4, 2:1)OutOfHome-ECS	Not Set
Respite-Life Sharing-Day(Lvl 4,2:1 Enh)Out-of-Home	Not Set
Respite-Life Sharing-Day(Lvl 4-2:1 Enh)OutHome-ECS	Not Set
Respite-Life Sharing-Day(Lvl3,1:1 Enh)OutHomECS RN	Not Set
Respite-Life Sharing-Day(Lvl3,1:1 Enh)OutOfHome-RN	Not Set
Respite-Life Sharing-Day(Lvl4,2:1 Enh)OutOfHome-RN	Not Set
Respite-Life Sharing-Day(Lvl4,2:1Enh)OutHomeECS RN	Not Set
Respite-Unlic,15-min(Level 3, 1:1 Enhcd)ECS	Not Set
Respite-Unlic,15-min(Level 3, 1:1 Enhcd)ECS - TD	Not Set
Respite-Unlic,15-min(Level 3, 1:1 Enhcd)ECS - TE	Not Set
Respite-Unlic- 15-min (Basic 1:4)	Not Set
Respite-Unlic- 15-min (Basic 1:4) ECS	Not Set
Respite-Unlic- 15-min(Level 3, 1:1 Enhcd)	Not Set
Respite-Unlic- 15-min(Level 3, 1:1 Enhcd) - TD	Not Set
Respite-Unlic- 15-min(Level 3, 1:1 Enhcd) - TE	Not Set
Respite-Unlic-15-min(Level 1, 1:3) Out-of-Home	Not Set
Respite-Unlic-15-min(Level 2, 1:2)Out-of-Home	Not Set
Respite-Unlic-15-min(Level 3, 1:1)Out-of-Home	Not Set
Respite-Unlic-15-min(Level 4, 2:1 Enh) - TD	Not Set
Respite-Unlic-15-min(Level 4, 2:1 Enh) - TE	Not Set
Respite-Unlic-15-min(Level 4, 2:1 Enh) ECS - TD	Not Set
Respite-Unlic-15-min(Level 4, 2:1 Enh) ECS - TE	Not Set
Respite-Unlic-15-min(Level 4, 2:1 Enhanced)	Not Set
Respite-Unlic-15-min(Level 4, 2:1 Enhanced) ECS	Not Set
Respite-Unlic-15-min(Lvl 1, 1:3) Out-of-Home-ECS	Not Set
Respite-Unlic-15-min(Lvl 2, 1:2)Out-of-Home-ECS	Not Set
Respite-Unlic-15-min(Lvl 3, 1:1)Out-of-Home-ECS	Not Set
Respite-Unlic-15min(Lvl 4,2:1) Out of Home	Not Set
Respite-Unlic-15min(Lvl 4,2:1)Out-of-Home-ECS	Not Set
Respite-Unlic-Day (Basic 1:4) Out-of-Home	Not Set
Respite-Unlic-Day (Basic 1:4) Out-of-Home-ECS	Not Set
Respite-Unlic-Day (Level 1, 1:3) Out-of-Home	Not Set
Respite-Unlic-Day (Level 1, 1:3) Out-of-Home-ECS	Not Set
Respite-Unlic-Day (Level 2, 1:2) Out-of-Home	Not Set
Respite-Unlic-Day (Level 2, 1:2) Out-of-Home-ECS	Not Set
Respite-Unlic-Day (Level 3, 1:1 Enh) Out-of-Home	Not Set
Respite-Unlic-Day (Level 3, 1:1 Enh)Out-of-Hme -TD	Not Set
Respite-Unlic-Day (Level 3, 1:1 Enh)Out-of-Hme -TE	Not Set
Respite-Unlic-Day (Level 3, 1:1) Out-of-Home	Not Set
Respite-Unlic-Day (Level 3, 1:1) Out-of-Home-ECS	Not Set
Respite-Unlic-Day (Level 4, 2:1) ECS-Out-of-Home	Not Set
Respite-Unlic-Day (Level 4, 2:1) Out-of-Home	Not Set
Respite-Unlic-Day(Level 3, 1:1 Enh)Out-of-Home-ECS	Not Set
Respite-Unlic-Day(Level 3, 1:1 Enh)OutofHme-ECS-TD	Not Set
Respite-Unlic-Day(Level 3, 1:1 Enh)OutofHme-ECS-TE	Not Set
Respite-Unlic-Day(Level 4, 2:1 Enh) Out-of-Home-TD	Not Set
Respite-Unlic-Day(Level 4, 2:1 Enh) Out-of-Home-TE	Not Set
Respite-Unlic-Day(Level 4, 2:1 Enhcd) Out-of-Home	Not Set
Respite-Unlic-Day(Lvl 4-2:1 Enh)Out-of-Home-ECS-TD	Not Set
Respite-Unlic-Day(Lvl 4-2:1 Enh)Out-of-Home-ECS-TE	Not Set
Respite-Unlic-Day(Lvl 4-2:1 Enhcd)Out-of-Home-ECS	Not Set
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.
Supplemental Habilitation 1:1 - 15 min - ECS	Not Set
Supplemental Habilitation 2:1 - 15 min	$12.22 / 15 min.
Supplemental Habilitation 2:1 - 15 min - ECS	Not Set
Transportation(Zone 1)-Trip	$36.54 / Trip
Transportation(Zone 2)-Trip	$65.78 / Trip
Transportation(Zone 3)-Trip	$74.73 / Trip

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