Basic Information
| Provider Information | |||||||||
| NPI: | 1659369643 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MILLVILLE LEASING PARTNERSHIP | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MILLVILLE HEALTH CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 48 HAVEN LANE | ||||||||
| Address2: | |||||||||
| City: | MILLVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704585566 | ||||||||
| FaxNumber: | 5704584050 | ||||||||
| Practice Location | |||||||||
| Address1: | 48 HAVEN LANE | ||||||||
| Address2: | |||||||||
| City: | MILLVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704585566 | ||||||||
| FaxNumber: | 5704584050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 08/11/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HAYMAN | ||||||||
| AuthorizedOfficialFirstName: | FRANCIS | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT LEHIGH NURSING CORP | ||||||||
| AuthorizedOfficialTelephone: | 6102648000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 022202 | PA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 1007557700006 | 05 | PA | MEDICAID |