Provider Demographics
NPI:1255329645
Name:LANCASTER LEASING PARTNERSHIP
Entity Type:Organization
Organization Name:LANCASTER LEASING PARTNERSHIP
Other - Org Name:AUDUBON VILLA NURSING HOME
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 1:125 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-1808
Mailing Address - Country:US
Mailing Address - Phone:717-626-0211
Mailing Address - Fax:717-626-4441
Practice Address - Street 1:125 S BROAD ST
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-1808
Practice Address - Country:US
Practice Address - Phone:717-626-0211
Practice Address - Fax:717-626-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA012302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007507380004Medicaid
PA1292730003Medicare NSC
PA1007507380004Medicaid