Provider Demographics
NPI:1497731467
Name:GREATER LEHIGH VALLEY VISITING NURSE ASSOCIATION, INC.
Entity Type:Organization
Organization Name:GREATER LEHIGH VALLEY VISITING NURSE ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCILLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, MBA
Authorized Official - Phone:610-378-0481
Mailing Address - Street 1:1170 BERKSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1215
Mailing Address - Country:US
Mailing Address - Phone:610-378-0481
Mailing Address - Fax:610-378-9762
Practice Address - Street 1:501 N 17TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5044
Practice Address - Country:US
Practice Address - Phone:610-395-2500
Practice Address - Fax:610-432-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA758405251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1009922OtherKEYSTONE MERCY
397584OtherCBC
521032OtherAETNA
0000822000OtherIBC MOTHER OPTIONS
0000824000OtherIBC BABY BLUE PRINT
1686OtherHIGHMARK
0000821000OtherIBC PRIVATE DUTY NURSING
PA0017455980001Medicaid
1009922OtherAMERIHEALTH MERCY
1138OtherGENTIVA CARE CENTRIX
0000820000OtherIBC
1009922OtherAMERIHEALTH MERCY
521032OtherAETNA