MEDICARE: LEHIGH VALLEY CHARTER HIGH SCHOOL FOR THE PERFORMING ARTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)		PA

General Provider Information

NPI Number	:	1356583868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEHIGH VALLEY CHARTER HIGH SCHOOL FOR THE PERFORMING ARTS

Provider Business Mailing Address
First Line	:	675 E BROAD ST
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18018-6332
Country	:	US
Telephone Number	:	610-868-2971
Fax Number	:	610-868-1811

Provider Business Practice Location Address
First Line	:	675 E BROAD ST
Second Line	:
City	:	BETHLEHEM
State	:	PA
Zip	:	18018-6332
Country	:	US
Telephone Number	:	610-868-2971
Fax Number	:	610-868-1811

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	DR. THOMAS S LUBBEN
Credential	:	ED.D.
Telephone Number	:	610-868-2971

Provider Enumeration Date	:	03/30/2009
Last Update Date	:	03/30/2009

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