Healthcare Provider Details

I. General information

NPI: 1831335009
Provider Name (Legal Business Name): BLUE MOUNTAIN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 03/01/2020
Certification Date: 03/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 IRON ST
LEHIGHTON PA
18235-1949
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 610-379-4880
  • Fax: 610-379-4883
Mailing address:
  • Phone: 610-377-7003
  • Fax: 610-377-7920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number420601
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number420601
License Number StatePA

VIII. Authorized Official

Name: MR. THOMAS LICHTENWALNER
Title or Position: SR VP FINANCE
Credential:
Phone: 484-526-3114