Healthcare Provider Details

I. General information

NPI: 1750488995
Provider Name (Legal Business Name): PALMERTON HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 LAFAYETTE AVE
PALMERTON PA
18071-1518
US

IV. Provider business mailing address

135 LAFAYETTE AVE
PALMERTON PA
18071-1518
US

V. Phone/Fax

Practice location:
  • Phone: 610-826-3141
  • Fax: 610-377-7176
Mailing address:
  • Phone: 610-826-3141
  • Fax: 610-377-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number420601
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number920080
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number420601
License Number StatePA

VIII. Authorized Official

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