Provider Demographics
NPI:1093855074
Name:LEHIGH COUNTY MHMR PROGRAM
Entity Type:Organization
Organization Name:LEHIGH COUNTY MHMR PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:TIM
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-782-3551
Mailing Address - Street 1:17 S 7TH ST
Mailing Address - Street 2:LEHIGH CTY GVT CENTER
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18101-2401
Mailing Address - Country:US
Mailing Address - Phone:610-782-3000
Mailing Address - Fax:
Practice Address - Street 1:17 S 7TH ST
Practice Address - Street 2:LEHIGH CTY GVT CENTER
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18101-2401
Practice Address - Country:US
Practice Address - Phone:610-782-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100007238Medicaid
PA1000072380048Medicaid