1265432165 NPI number — COUNTRY MEADOWS OF NORTHAMPTON ASSOCIATES, LP

Table of content: (NPI 1265432165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265432165 NPI number — COUNTRY MEADOWS OF NORTHAMPTON ASSOCIATES, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTRY MEADOWS OF NORTHAMPTON ASSOCIATES, LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COUNTRY MEADOWS NURSING CENTER OF BETHLEHEM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265432165
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
830 CHERRY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERSHEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17033-2007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-533-2474
Provider Business Mailing Address Fax Number:
717-533-1014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4025 GREEN POND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18020-9662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-882-4110
Provider Business Practice Location Address Fax Number:
610-882-4311
Provider Enumeration Date:
07/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MIZAK
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
VP- FINANCE, ACCOUNTING, INFOR SRVS
Authorized Official Telephone Number:
717-533-2474

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  096802 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1026761200001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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