Provider Demographics
NPI:1093769275
Name:SACRED HEART HOSPITAL
Entity Type:Organization
Organization Name:SACRED HEART HOSPITAL
Other - Org Name:SACRED HEART VISITING NURSES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, VISITING NURSES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-871-2802
Mailing Address - Street 1:2268 S 12TH ST
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5642
Mailing Address - Country:US
Mailing Address - Phone:610-871-2802
Mailing Address - Fax:610-871-5919
Practice Address - Street 1:2268 S 12TH ST
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-5642
Practice Address - Country:US
Practice Address - Phone:610-871-2802
Practice Address - Fax:610-871-5919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA771505251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007275420041Medicaid
1812OtherHIGHMARK BLUE SHIELD
397715OtherCAPITAL BLUE CROSS
397715Medicare ID - Type Unspecified