1952392193 NPI number — LIBERTY LUTHERAN HOUSING DEVELOPMENT CORPORATION

Table of content: (NPI 1952392193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952392193 NPI number — LIBERTY LUTHERAN HOUSING DEVELOPMENT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIBERTY LUTHERAN HOUSING DEVELOPMENT CORPORATION
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:
THE VILLAGE AT PENN STATE
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:
1952392193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 N BETHLEHEM PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMBLER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19002-3524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-643-9921
Provider Business Mailing Address Fax Number:
215-643-6791

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 LIONS HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16803-1859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-238-1949
Provider Business Practice Location Address Fax Number:
814-238-2884
Provider Enumeration Date:
11/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CORBIN
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
814-238-1949

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  15550201 , 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)





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