Provider Demographics
NPI:1326033556
Name:ST. LUKE'S HOSPITAL
Entity Type:Organization
Organization Name:ST. LUKE'S HOSPITAL
Other - Org Name:THE SUMMIT AT BLUE MOUNTAIN NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-526-4000
Mailing Address - Street 1:211 N. 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-1138
Mailing Address - Country:US
Mailing Address - Phone:610-377-4732
Mailing Address - Fax:610-377-4758
Practice Address - Street 1:211 N. 12TH STREET
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1138
Practice Address - Country:US
Practice Address - Phone:610-377-7154
Practice Address - Fax:610-377-7939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
PA070502314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007467723Medicaid
PA395276Medicare ID - Type UnspecifiedPROVIDER NUMBER