Provider Demographics
NPI:1184035339
Name:LEBANON VALLEY MIDWIFERY & WOMEN'S WELLNESS, LLC
Entity Type:Organization
Organization Name:LEBANON VALLEY MIDWIFERY & WOMEN'S WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:717-933-9743
Mailing Address - Street 1:770 HOST RD
Mailing Address - Street 2:
Mailing Address - City:WOMELSDORF
Mailing Address - State:PA
Mailing Address - Zip Code:19567-9100
Mailing Address - Country:US
Mailing Address - Phone:717-933-9743
Mailing Address - Fax:717-933-8289
Practice Address - Street 1:770 HOST RD
Practice Address - Street 2:
Practice Address - City:WOMELSDORF
Practice Address - State:PA
Practice Address - Zip Code:19567-9100
Practice Address - Country:US
Practice Address - Phone:717-933-9743
Practice Address - Fax:717-933-8289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102422745 0001Medicaid
PA102422745 0001Medicaid