Basic Information
| Provider Information | |||||||||
| NPI: | 1942439385 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEIGHBORHOOD HEALTH CENTERS OF THE LEHIGH VALLEY | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | VIDA NUEVA AT THE CARING PLACE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 931 HAMILTON ST | ||||||||
| Address2: | FOURTH FLOOR | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181011140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104334680 | ||||||||
| FaxNumber: | 6104334707 | ||||||||
| Practice Location | |||||||||
| Address1: | 931 HAMILTON ST | ||||||||
| Address2: | FOURTH FLOOR | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181011140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104334680 | ||||||||
| FaxNumber: | 6104334707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2009 | ||||||||
| LastUpdateDate: | 05/28/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SECKINGER | ||||||||
| AuthorizedOfficialFirstName: | LEE | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6104334680 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEIGHBORHOOD HEALTH CENTERS OF THE LEHIGH VALLEY | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | MD062907L | PA | N | Ambulatory Health Care Facilities | Clinic/Center | 261QC1500X | MD062907L | PA | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
ID Information
| ID | Type | State | Issuer | Description | 1023235130001 | 05 | PA | MEDICAID |