Basic Information
| Provider Information | |||||||||
| NPI: | 1770874505 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ORANGEVILLE LEASING PARTNERSHIP | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | PENNMED SPORTS AND REHAB AT ORANGEVILLE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 200 BERWICK RD | ||||||||
| Address2: | |||||||||
| City: | ORANGEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178599064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706835036 | ||||||||
| FaxNumber: | 5706835403 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 BERWICK RD | ||||||||
| Address2: | |||||||||
| City: | ORANGEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178599064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706835036 | ||||||||
| FaxNumber: | 5706835403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2011 | ||||||||
| LastUpdateDate: | 04/27/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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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 | 261QP2000X | 379502 | PA | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
ID Information
| ID | Type | State | Issuer | Description | 0017836790004 | 05 | PA | MEDICAID |