Provider Demographics
NPI:1326086539
Name:SACRED HEART HOSPITAL OF ALLENTOWN
Entity Type:Organization
Organization Name:SACRED HEART HOSPITAL OF ALLENTOWN
Other - Org Name:SACRED HEART HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-776-4713
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:2006-06-02
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16661601251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007275420042Medicaid
PA1007275420042Medicaid