Provider Demographics
NPI:1528388220
Name:VIDA NUEVA AT CASA GUADALUPE OB
Entity Type:Organization
Organization Name:VIDA NUEVA AT CASA GUADALUPE OB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SECKINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-433-4680
Mailing Address - Street 1:218 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3508
Mailing Address - Country:US
Mailing Address - Phone:610-841-8400
Mailing Address - Fax:610-841-8401
Practice Address - Street 1:218 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3508
Practice Address - Country:US
Practice Address - Phone:610-841-8400
Practice Address - Fax:610-841-8401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEIGHBORHOOD HEALTH CENTERS OF THE LEHIGH VALLEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty