Healthcare Provider Details

I. General information

NPI: 1356789358
Provider Name (Legal Business Name): SENIORLIFE LEHIGH VALLEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3365 HIGH POINT BLVD
BETHLEHEM PA
18017-7806
US

IV. Provider business mailing address

209 SIGMA DR
PITTSBURGH PA
15238-2826
US

V. Phone/Fax

Practice location:
  • Phone: 610-954-5433
  • Fax: 610-691-1075
Mailing address:
  • Phone: 412-963-9150
  • Fax: 412-963-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number335230
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number325574
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number StatePA

VIII. Authorized Official

Name: MR. HERBERT H HENNELL
Title or Position: DIR. OF REIMBURSEMENT
Credential:
Phone: 412-963-9150