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General NPI Number Information
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NPI Number | 1104142868
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Entity Type | Organization
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Legal Business Name | PHOEBE HOME
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 04/20/2010
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Provider Practice Location Address
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Address Line | 1925 W TURNER ST
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City | ALLENTOWN
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State | PA
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Zip | 18104-5513
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Country | US
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Telephone | 610-794-5261
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Fax | 610-794-5457
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Provider Business Mailing Address
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Address Line | 1925 W TURNER ST
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City | ALLENTOWN
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State | PA
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Zip | 18104-5513
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Country | US
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Telephone | 610-794-5261
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Fax | 610-794-5457
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Authorized Official
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Title or Position | LPT
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Name | MRS. ALICE DONLAN
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Credential |
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Telephone | 610-794-5162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | OC001919-L
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License Number State | PA
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