Healthcare Provider Details

I. General information

NPI: 1952392193
Provider Name (Legal Business Name): LIBERTY LUTHERAN HOUSING DEVELOPMENT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 LIONS HILL RD
STATE COLLEGE PA
16803-1859
US

IV. Provider business mailing address

250 N BETHLEHEM PIKE
AMBLER PA
19002-3524
US

V. Phone/Fax

Practice location:
  • Phone: 814-238-1949
  • Fax: 814-238-2884
Mailing address:
  • Phone: 215-643-9921
  • Fax: 215-643-6791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number15550201
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ELLEN CORBIN
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 814-238-1949