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PROVIDER DEMOGRAPHIC INFORMATION Supporting line for group header


Name:	SAMARITANS AT LAST LLC
Address:	1055 WESTLAKES DR SUITE 300 BERWYN, PA 19312-2410
Phone:	(610) 566-1361
Fax:	(610) 500-5223
E-mail:	michelle.crutchley@samaritansatlast.org
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:	Samaritans At Last, llc
Address:	1055 WESTLAKES DR STE 300 BERWYN, PA 19312-2410
Phone:	(610) 566-1361
Fax:	(610) 500-5223

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PROVIDER SERVICES AND RATES Supporting line for group header


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

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-Lic-1 Person-Inelig	$99.10 / 1 Day
Res Hab-Lic-2 Person-Inelig	$54.05 / 1 Day
Respite-Unlic-15-min(Level 3, 1:1)In-Home	$7.95 / 15 min.
Supplemental Habilitation 1:1 - 15 min	$5.77 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$11.53 / 15 min.

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

Behavioral Supports-Level 1-Initial/Ongoing	$22.08 / 15 min.
Companion Services (Basic Staff Support)	$3.19 / 15 min.
Companion Services (Level 1)	$4.42 / 15 min.
Companion Services (Level 2)	$7.71 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.09 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$5.76 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$10.28 / 15 min.
In-Home & Commnty Supprts (Lvl 3)	$19.83 / 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-Lic-1 Person-Inelig	$99.10 / 1 Day
Res Hab-Lic-2 Person-Inelig	$54.05 / 1 Day
Respite-Unlic- 15-min (Basic 1:4)	$2.26 / 15 min.
Respite-Unlic-15-min(Level 1, 1:3) In-Home	$2.98 / 15 min.
Respite-Unlic-15-min(Level 2, 1:2)In-Home	$4.40 / 15 min.
Respite-Unlic-15-min(Level 3, 1:1)In-Home	$7.95 / 15 min.
Respite-Unlic-15-min(Lvl 4, 2:1) In-Home	$15.77 / 15 min.
Respite-Unlic-Day (Basic 1:4) In-Home	$90.59 / 1 Day
Respite-Unlic-Day (Level 1, 1:3) In-Home	$119.11 / 1 Day
Respite-Unlic-Day (Level 3, 1:1) In-Home	$317.80 / 1 Day
Respite-Unlic-Day (Level 4, 2:1) In-Home	$630.98 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$5.77 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$11.53 / 15 min.

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

Behavioral Supports-Level 1-Initial/Ongoing	$22.08 / 15 min.
Companion Services (Basic Staff Support)	$3.19 / 15 min.
Companion Services (Level 1)	$4.42 / 15 min.
Companion Services (Level 2)	$7.71 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.09 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$5.76 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$10.28 / 15 min.
In-Home & Commnty Supprts (Lvl 3)	$19.83 / 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-Lic-1 Person-Inelig	$99.10 / 1 Day
Res Hab-Lic-2 Person-Inelig	$54.05 / 1 Day
Respite-Unlic- 15-min (Basic 1:4)	$2.26 / 15 min.
Respite-Unlic-15-min(Level 1, 1:3) In-Home	$2.98 / 15 min.
Respite-Unlic-15-min(Level 2, 1:2)In-Home	$4.40 / 15 min.
Respite-Unlic-15-min(Level 3, 1:1)In-Home	$7.95 / 15 min.
Respite-Unlic-15-min(Lvl 4, 2:1) In-Home	$15.77 / 15 min.
Respite-Unlic-Day (Basic 1:4) In-Home	$90.59 / 1 Day
Respite-Unlic-Day (Level 1, 1:3) In-Home	$119.11 / 1 Day
Respite-Unlic-Day (Level 3, 1:1) In-Home	$317.80 / 1 Day
Respite-Unlic-Day (Level 4, 2:1) In-Home	$630.98 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$5.77 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$11.53 / 15 min.

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

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
Supplemental Habilitation 1:1 - 15 min	$5.77 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$11.53 / 15 min.

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

Behavioral Supports-Level 1-Initial/Ongoing	$22.08 / 15 min.
Companion Services (Basic Staff Support)	$3.19 / 15 min.
Companion Services (Level 1)	$4.42 / 15 min.
Companion Services (Level 2)	$7.71 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.09 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$5.76 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$10.28 / 15 min.
In-Home & Commnty Supprts (Lvl 3)	$19.83 / 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-Lic-1 Person-Inelig	$99.10 / 1 Day
Res Hab-Lic-2 Person-Inelig	$54.05 / 1 Day
Respite-Unlic- 15-min (Basic 1:4)	$2.26 / 15 min.
Respite-Unlic-15-min(Level 1, 1:3) In-Home	$2.98 / 15 min.
Respite-Unlic-15-min(Level 2, 1:2)In-Home	$4.40 / 15 min.
Respite-Unlic-15-min(Level 3, 1:1)In-Home	$7.95 / 15 min.
Respite-Unlic-15-min(Lvl 4, 2:1) In-Home	$15.77 / 15 min.
Respite-Unlic-Day (Basic 1:4) In-Home	$90.59 / 1 Day
Respite-Unlic-Day (Level 1, 1:3) In-Home	$119.11 / 1 Day
Respite-Unlic-Day (Level 2, 1:2) In-Home	$176.17 / 1 Day
Respite-Unlic-Day (Level 3, 1:1) In-Home	$317.80 / 1 Day
Respite-Unlic-Day (Level 4, 2:1) In-Home	$630.98 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$5.77 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$11.53 / 15 min.

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

Behavioral Supports-Level 1-Initial/Ongoing	$22.08 / 15 min.
Companion Services (Basic Staff Support)	$3.19 / 15 min.
Companion Services (Level 1)	$4.42 / 15 min.
Companion Services (Level 2)	$7.71 / 15 min.
In-Home & Commnty Supprts (Basic)	$4.09 / 15 min.
In-Home & Commnty Supprts (Lvl 1)	$5.76 / 15 min.
In-Home & Commnty Supprts (Lvl 2)	$10.28 / 15 min.
In-Home & Commnty Supprts (Lvl 3)	$19.83 / 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-Lic-1 Person-Inelig	$99.10 / 1 Day
Res Hab-Lic-2 Person-Inelig	$54.05 / 1 Day
Respite-Unlic- 15-min (Basic 1:4)	$2.26 / 15 min.
Respite-Unlic-15-min(Level 1, 1:3) In-Home	$2.98 / 15 min.
Respite-Unlic-15-min(Level 2, 1:2)In-Home	$4.40 / 15 min.
Respite-Unlic-15-min(Level 3, 1:1)In-Home	$7.95 / 15 min.
Respite-Unlic-15-min(Lvl 4, 2:1) In-Home	$15.77 / 15 min.
Respite-Unlic-Day (Basic 1:4) In-Home	$90.59 / 1 Day
Respite-Unlic-Day (Level 1, 1:3) In-Home	$119.11 / 1 Day
Respite-Unlic-Day (Level 2, 1:2) In-Home	$176.17 / 1 Day
Respite-Unlic-Day (Level 3, 1:1) In-Home	$317.80 / 1 Day
Respite-Unlic-Day (Level 4, 2:1) In-Home	$630.98 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$5.77 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$11.53 / 15 min.

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