Provider Demographics
NPI:1710968458
Name:MORAVIAN VILLAGE OF BETHLEHEM, INC.
Entity Type:Organization
Organization Name:MORAVIAN VILLAGE OF BETHLEHEM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-625-4885
Mailing Address - Street 1:526 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-4453
Mailing Address - Country:US
Mailing Address - Phone:610-625-4885
Mailing Address - Fax:610-625-2032
Practice Address - Street 1:526 WOOD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-4453
Practice Address - Country:US
Practice Address - Phone:610-625-4885
Practice Address - Fax:610-625-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA15970201314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA39-6096Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PA396096Medicare Oscar/Certification