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Provider Demographic Information - LAKESHORE COMMUNITY SERVICES INC

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PROVIDER DEMOGRAPHIC INFORMATION Supporting line for group header


Name:	LAKESHORE COMMUNITY SERVICES INC
Address:	1350 W 26TH ST ERIE, PA 16508-1402
Phone:	(814) 456-9962
Fax:	(814) 456-0595
E-mail:	abenson@lakeshorecs.org
Web Site:	N/A

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PROVIDER CERTIFICATION INFORMATION Supporting line for group header

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

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PROVIDER SERVICES AND RATES Supporting line for group header


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

Behavioral Supports-Level 1-Initial/Ongoing	$22.08 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$10.28 / 15 min.
Res Hab-4 Person-NG 1-Elig-w/Day Supports	$232.07 / 1 Day
Res Hab-4 Person-NG 2-Elig-w/Day Supports	$268.22 / 1 Day
Res Hab-4 Person-NG 3-Elig-w/Day Supports	$341.91 / 1 Day
Res Hab-4 Person-NG 4-Elig-w/Day Supports	$376.12 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 1	$304.14 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 2	$347.00 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 3	$401.47 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 4	$481.66 / 1 Day
Res Hab-Lic-4 Person-Inelig	$25.61 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$5.77 / 15 min.

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

Behavioral Supports-Level 1-Initial/Ongoing	$22.08 / 15 min.
CPS Community 1:1	$12.81 / 15 min.
CPS Community 1:2 or 1:3	$6.98 / 15 min.
CPS Community 2:1	$24.62 / 15 min.
CPS Community 2:3	$10.43 / 15 min.
CPS Facility 1:1	$12.40 / 15 min.
CPS Facility 1:1 Enhanced	$17.27 / 15 min.
CPS Facility 1:1 Enhcd LPN	$17.27 / 15 min.
CPS Facility 1:1 Enhcd RN	$17.27 / 15 min.
CPS Facility 1:11 to 1:15	$2.96 / 15 min.
CPS Facility 1:2 to 1:3	$6.84 / 15 min.
CPS Facility 1:4 to 1:6	$5.23 / 15 min.
CPS Facility 1:7 to 1:10	$3.18 / 15 min.
CPS Facility 2:1	$23.77 / 15 min.
CPS Facility 2:1 Enhcd	$28.65 / 15 min.
CPS Facility 2:1 Enhcd LPN	$28.65 / 15 min.
CPS Facility 2:1 Enhcd RN	$28.65 / 15 min.
CPS: Community OnCall/Remote Support	$1.64 / 15 min.
CPS:Community OnCall/Remote Support	$1.64 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$10.28 / 15 min.
Res Hab-2 Person-NG 1-Elig	$523.00 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$408.54 / 1 Day
Res Hab-2 Person-NG 2-Elig	$606.92 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$515.01 / 1 Day
Res Hab-2 Person-NG 3-Elig	$685.68 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$630.70 / 1 Day
Res Hab-2 Person-NG 4-Elig	$820.15 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$689.49 / 1 Day
Res Hab-3 Person-NG 1-Elig	$387.76 / 1 Day
Res Hab-3 Person-NG 1-Elig-w/Day Supports	$294.49 / 1 Day
Res Hab-3 Person-NG 2-Elig	$441.87 / 1 Day
Res Hab-3 Person-NG 2-Elig-w/Day Supports	$341.21 / 1 Day
Res Hab-3 Person-NG 3-Elig	$514.20 / 1 Day
Res Hab-3 Person-NG 3-Elig-w/Day Supports	$440.90 / 1 Day
Res Hab-3 Person-NG 4-Elig	$624.74 / 1 Day
Res Hab-3 Person-NG 4-Elig-w/Day Supports	$484.03 / 1 Day
Res Hab-4 Person-NG 1-Elig-w/Day Supports	$232.07 / 1 Day
Res Hab-4 Person-NG 2-Elig-w/Day Supports	$268.22 / 1 Day
Res Hab-4 Person-NG 3-Elig-w/Day Supports	$341.91 / 1 Day
Res Hab-4 Person-NG 4-Elig-w/Day Supports	$376.12 / 1 Day
Res Hab-Lic-2 Person-Inelig	$47.38 / 1 Day
Res Hab-Lic-3 Person-Inelig	$33.46 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 1	$304.14 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 2	$347.00 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 3	$401.47 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 4	$481.66 / 1 Day
Res Hab-Lic-4 Person-Inelig	$25.61 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$5.77 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$11.53 / 15 min.

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

Behavioral Supports-Level 1-Initial/Ongoing	$22.08 / 15 min.
CPS Community 1:1	$12.81 / 15 min.
CPS Community 1:2 or 1:3	$6.98 / 15 min.
CPS Community 2:1	$24.62 / 15 min.
CPS Community 2:3	$10.43 / 15 min.
CPS: Community OnCall/Remote Support	$1.64 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$5.76 / 15 min.
In-Home & Commnty Supprts (Lvl 2 Enh)	$14.18 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$10.28 / 15 min.
In-Home & Commnty Supprts (Lvl 3)	$19.83 / 15 min.
Life Sharing-1 per-Elig-Unlic < 30 Hrs	$147.63 / 1 Day
Life Sharing-2 per-Elig-Unlic < 30 Hrs	$105.13 / 1 Day
Res Hab-1 Person-NG 1-Elig	$523.00 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$408.54 / 1 Day
Res Hab-1 Person-NG 2-Elig	$606.92 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$515.01 / 1 Day
Res Hab-1 Person-NG 3-Elig	$924.89 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$746.22 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,118.74 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$822.23 / 1 Day
Res Hab-2 Person-NG 1-Elig	$523.00 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$408.54 / 1 Day
Res Hab-2 Person-NG 2-Elig	$606.92 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$515.01 / 1 Day
Res Hab-2 Person-NG 3-Elig	$685.68 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$630.70 / 1 Day
Res Hab-2 Person-NG 4-Elig	$820.15 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$689.49 / 1 Day
Res Hab-3 Person-NG 1-Elig	$387.76 / 1 Day
Res Hab-3 Person-NG 1-Elig-w/Day Supports	$294.49 / 1 Day
Res Hab-3 Person-NG 2-Elig	$441.87 / 1 Day
Res Hab-3 Person-NG 2-Elig-w/Day Supports	$341.21 / 1 Day
Res Hab-3 Person-NG 3-Elig	$514.20 / 1 Day
Res Hab-3 Person-NG 3-Elig-w/Day Supports	$440.90 / 1 Day
Res Hab-3 Person-NG 4-Elig	$624.74 / 1 Day
Res Hab-3 Person-NG 4-Elig-w/Day Supports	$484.03 / 1 Day
Res Hab-4 Person-NG 1-Elig-w/Day Supports	$232.07 / 1 Day
Res Hab-4 Person-NG 2-Elig-w/Day Supports	$268.22 / 1 Day
Res Hab-4 Person-NG 3-Elig-w/Day Supports	$341.91 / 1 Day
Res Hab-4 Person-NG 4-Elig-w/Day Supports	$376.12 / 1 Day
Res Hab-5-8 Person-NG 1-Elig	$267.15 / 1 Day
Res Hab-5-8 Person-NG 1-Elig-w/Day Supports	$212.03 / 1 Day
Res Hab-5-8 Person-NG 2-Elig	$311.99 / 1 Day
Res Hab-5-8 Person-NG 2-Elig-w/Day Supports	$250.71 / 1 Day
Res Hab-5-8 Person-NG 3-Elig	$360.24 / 1 Day
Res Hab-5-8 Person-NG 3-Elig-w/Day Supports	$314.42 / 1 Day
Res Hab-5-8 Person-NG 4-Elig	$429.04 / 1 Day
Res Hab-5-8 Person-NG 4-Elig-w/Day Supports	$338.58 / 1 Day
Res Hab-Lic-1 Person-Inelig	$88.34 / 1 Day
Res Hab-Lic-2 Person-Inelig	$47.38 - $54.05 / 1 Day
Res Hab-Lic-3 Person-Inelig	$33.46 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 1	$304.14 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 2	$347.00 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 3	$401.47 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 4	$481.66 / 1 Day
Res Hab-Lic-4 Person-Inelig	$25.61 / 1 Day
Res Hab-Lic-5-8 Person-Inelig	$17.86 / 1 Day
Resid Hab-Unlic 1-Indiv Home (Inelig)	$23.74 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$5.77 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$11.53 / 15 min.
Support (Medical Environment) (Level 3)-15 Mins	Not Set
Supported Emplymnt-Career Assessment	$17.91 / 15 min.
Supported Emplymnt-Job Finding/Job Development	$17.91 / 15 min.
Supported Emplymnt-Job Support - 1:1	$17.91 / 15 min.
Supported Emplymnt-Job Support-1:2	$10.72 / 15 min.

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

Behavioral Supports-Level 1-Initial/Ongoing	$22.08 / 15 min.
CPS Community 1:1	$12.81 / 15 min.
CPS Community 1:2 or 1:3	$6.98 / 15 min.
CPS Community 2:1	$24.62 / 15 min.
CPS Community 2:3	$10.43 / 15 min.
CPS Facility 1:1	$12.40 / 15 min.
CPS Facility 1:1 Enhanced	$17.27 / 15 min.
CPS Facility 1:1 Enhcd LPN	$17.27 / 15 min.
CPS Facility 1:1 Enhcd RN	$17.27 / 15 min.
CPS Facility 1:11 to 1:15	$2.96 / 15 min.
CPS Facility 1:2 to 1:3	$6.84 / 15 min.
CPS Facility 1:4 to 1:6	$5.23 / 15 min.
CPS Facility 1:7 to 1:10	$3.18 / 15 min.
CPS Facility 2:1	$23.77 / 15 min.
CPS Facility 2:1 Enhcd	$28.65 / 15 min.
CPS Facility 2:1 Enhcd LPN	$28.65 / 15 min.
CPS Facility 2:1 Enhcd RN	$28.65 / 15 min.
CPS: Community OnCall/Remote Support	$1.64 / 15 min.
CPS:Community OnCall/Remote Support	$1.64 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$5.76 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$10.28 / 15 min.
Res Hab-1 Person-NG 1-Elig	$523.00 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$408.54 / 1 Day
Res Hab-1 Person-NG 2-Elig	$606.92 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$515.01 / 1 Day
Res Hab-1 Person-NG 3-Elig	$924.89 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$746.22 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,118.74 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$822.23 / 1 Day
Res Hab-2 Person-NG 1-Elig	$523.00 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$408.54 / 1 Day
Res Hab-2 Person-NG 2-Elig	$606.92 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$515.01 / 1 Day
Res Hab-2 Person-NG 3-Elig	$685.68 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$630.70 / 1 Day
Res Hab-2 Person-NG 4-Elig	$820.15 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$689.49 / 1 Day
Res Hab-3 Person-NG 1-Elig	$387.76 / 1 Day
Res Hab-3 Person-NG 1-Elig-w/Day Supports	$294.49 / 1 Day
Res Hab-3 Person-NG 2-Elig	$441.87 / 1 Day
Res Hab-3 Person-NG 2-Elig-w/Day Supports	$341.21 / 1 Day
Res Hab-3 Person-NG 3-Elig	$514.20 / 1 Day
Res Hab-3 Person-NG 3-Elig-w/Day Supports	$440.90 / 1 Day
Res Hab-3 Person-NG 4-Elig	$624.74 / 1 Day
Res Hab-3 Person-NG 4-Elig-w/Day Supports	$484.03 / 1 Day
Res Hab-4 Person-NG 1-Elig-w/Day Supports	$232.07 / 1 Day
Res Hab-4 Person-NG 2-Elig-w/Day Supports	$268.22 / 1 Day
Res Hab-4 Person-NG 3-Elig-w/Day Supports	$341.91 / 1 Day
Res Hab-4 Person-NG 4-Elig-w/Day Supports	$376.12 / 1 Day
Res Hab-Lic-1 Person-Inelig	$88.34 / 1 Day
Res Hab-Lic-2 Person-Inelig	$47.38 - $54.05 / 1 Day
Res Hab-Lic-3 Person-Inelig	$33.46 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 1	$304.14 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 2	$347.00 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 3	$401.47 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 4	$481.66 / 1 Day
Res Hab-Lic-4 Person-Inelig	$25.61 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$5.77 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$11.53 / 15 min.

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

Behavioral Supports-Level 1-Initial/Ongoing	$22.08 / 15 min.
Res Hab-4 Person-NG 1-Elig-w/Day Supports	$232.07 / 1 Day
Res Hab-4 Person-NG 2-Elig-w/Day Supports	$268.22 / 1 Day
Res Hab-4 Person-NG 3-Elig-w/Day Supports	$341.91 / 1 Day
Res Hab-4 Person-NG 4-Elig-w/Day Supports	$376.12 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 1	$304.14 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 2	$347.00 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 3	$401.47 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 4	$481.66 / 1 Day
Res Hab-Lic-4 Person-Inelig	$25.61 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$5.77 / 15 min.

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

Behavioral Supports-Level 1-Initial/Ongoing	$22.08 / 15 min.
CPS Community 1:1	$12.81 / 15 min.
CPS Community 1:2 or 1:3	$6.98 / 15 min.
CPS Community 2:1	$24.62 / 15 min.
CPS Community 2:3	$10.43 / 15 min.
CPS Facility 1:1	$12.40 / 15 min.
CPS Facility 1:1 Enhanced	$17.27 / 15 min.
CPS Facility 1:1 Enhcd LPN	$17.27 / 15 min.
CPS Facility 1:1 Enhcd RN	$17.27 / 15 min.
CPS Facility 1:11 to 1:15	$2.96 / 15 min.
CPS Facility 1:2 to 1:3	$6.84 / 15 min.
CPS Facility 1:4 to 1:6	$5.23 / 15 min.
CPS Facility 1:7 to 1:10	$3.18 / 15 min.
CPS Facility 2:1	$23.77 / 15 min.
CPS Facility 2:1 Enhcd	$28.65 / 15 min.
CPS Facility 2:1 Enhcd LPN	$28.65 / 15 min.
CPS Facility 2:1 Enhcd RN	$28.65 / 15 min.
CPS: Community OnCall/Remote Support	$1.64 / 15 min.
CPS:Community OnCall/Remote Support	$1.64 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$5.76 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$10.28 / 15 min.
Res Hab-1 Person-NG 1-Elig	$523.00 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$408.54 / 1 Day
Res Hab-1 Person-NG 2-Elig	$606.92 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$515.01 / 1 Day
Res Hab-1 Person-NG 3-Elig	$924.89 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$746.22 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,118.74 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$822.23 / 1 Day
Res Hab-2 Person-NG 1-Elig	$523.00 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$408.54 / 1 Day
Res Hab-2 Person-NG 2-Elig	$606.92 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$515.01 / 1 Day
Res Hab-2 Person-NG 3-Elig	$685.68 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$630.70 / 1 Day
Res Hab-2 Person-NG 4-Elig	$820.15 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$689.49 / 1 Day
Res Hab-3 Person-NG 1-Elig	$387.76 / 1 Day
Res Hab-3 Person-NG 1-Elig-w/Day Supports	$294.49 / 1 Day
Res Hab-3 Person-NG 2-Elig	$441.87 / 1 Day
Res Hab-3 Person-NG 2-Elig-w/Day Supports	$341.21 / 1 Day
Res Hab-3 Person-NG 3-Elig	$514.20 / 1 Day
Res Hab-3 Person-NG 3-Elig-w/Day Supports	$440.90 / 1 Day
Res Hab-3 Person-NG 4-Elig	$624.74 / 1 Day
Res Hab-3 Person-NG 4-Elig-w/Day Supports	$484.03 / 1 Day
Res Hab-4 Person-NG 1-Elig-w/Day Supports	$232.07 / 1 Day
Res Hab-4 Person-NG 2-Elig-w/Day Supports	$268.22 / 1 Day
Res Hab-4 Person-NG 3-Elig-w/Day Supports	$341.91 / 1 Day
Res Hab-4 Person-NG 4-Elig-w/Day Supports	$376.12 / 1 Day
Res Hab-Lic-1 Person-Inelig	$88.34 / 1 Day
Res Hab-Lic-2 Person-Inelig	$47.38 / 1 Day
Res Hab-Lic-3 Person-Inelig	$33.46 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 1	$304.14 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 2	$347.00 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 3	$401.47 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 4	$481.66 / 1 Day
Res Hab-Lic-4 Person-Inelig	$25.61 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$5.77 / 15 min.

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

Life Sharing-1 per-Elig-Unlic < 30 Hrs	$147.63 / 1 Day
Resid Hab-Unlic 1-Indiv Home (Inelig)	$23.74 / 1 Day

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

Behavioral Supports-Level 1-Initial/Ongoing	$22.08 / 15 min.

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