Healthcare Provider Details

I. General information

NPI: 1417033655
Provider Name (Legal Business Name): ST. LUKE'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 610-954-4000
  • Fax:
Mailing address:
  • Phone: 610-954-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number451201
License Number StatePA

VIII. Authorized Official

Name: MS. ANDREA T ROSKO
Title or Position: EXECUTIVE DIRECTOR, SLPHO
Credential:
Phone: 610-954-4132