Provider Demographics
NPI:1043208291
Name:OVERLOOK LEASING PARTNERSHIP
Entity Type:Organization
Organization Name:OVERLOOK LEASING PARTNERSHIP
Other - Org Name:OVERLOOK MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT LEHIGH NURSING CORP
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAYMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:610-264-8000
Mailing Address - Street 1:520 S NEW CASTLE ST
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-1446
Mailing Address - Country:US
Mailing Address - Phone:724-946-3511
Mailing Address - Fax:724-946-8059
Practice Address - Street 1:520 S NEW CASTLE ST
Practice Address - Street 2:
Practice Address - City:NEW WILMINGTON
Practice Address - State:PA
Practice Address - Zip Code:16142-1446
Practice Address - Country:US
Practice Address - Phone:724-946-3511
Practice Address - Fax:724-946-8059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA150502314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007300740008Medicaid
PA395197Medicare Oscar/Certification
PA1292490002Medicare NSC