Healthcare Provider Details

I. General information

NPI: 1720259252
Provider Name (Legal Business Name): GNADEN HUETTEN MEMEORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 N 12TH ST BLDG 281
LEHIGHTON PA
18235-1101
US

IV. Provider business mailing address

211 NORTH 12TH STREET FINANCE OFFICE
LEHIGHTON PA
18235-1596
US

V. Phone/Fax

Practice location:
  • Phone: 610-377-1300
  • Fax:
Mailing address:
  • Phone: 610-377-7003
  • Fax: 610-377-4758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number070501
License Number StatePA

VIII. Authorized Official

Name: MRS. ANDREA L. ANDRAE
Title or Position: CFO
Credential:
Phone: 610-377-7003