Provider Demographics
NPI:1043215072
Name:COUNTY OF LEHIGH PENNSYLVANIA
Entity Type:Organization
Organization Name:COUNTY OF LEHIGH PENNSYLVANIA
Other - Org Name:CEDARBROOK LEHIGH CO HOMES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADID
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, MBS, NHA
Authorized Official - Phone:610-395-3727
Mailing Address - Street 1:350 S CEDARBROOK RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5708
Mailing Address - Country:US
Mailing Address - Phone:610-395-3727
Mailing Address - Fax:610-395-4737
Practice Address - Street 1:350 S CEDARBROOK RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5708
Practice Address - Country:US
Practice Address - Phone:610-395-3727
Practice Address - Fax:610-395-4737
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEHIGH CO CHIEF EX OFF
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-16
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA550102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAA08008670OtherMEDICARE DMERC
PA0005757700003Medicaid
PA1648OtherBLUE SHIELD
PA1000072380064Medicaid
PA1000072380063Medicaid
PA0005757700002Medicaid
PA0880250001Medicare NSC
PA1000072380063Medicaid