Provider Demographics
NPI:1730488388
Name:WELSH MOUNTAIN HEALTH CENTERS
Entity Type:Organization
Organization Name:WELSH MOUNTAIN HEALTH CENTERS
Other - Org Name:LEBANON RIDGE COMMUNITY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONCEPCION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-354-4711
Mailing Address - Street 1:584 SPRINGVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-9564
Mailing Address - Country:US
Mailing Address - Phone:717-354-4711
Mailing Address - Fax:717-354-0284
Practice Address - Street 1:840 NORMAN DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7444
Practice Address - Country:US
Practice Address - Phone:717-272-2700
Practice Address - Fax:717-272-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100761419Medicaid
391021Medicare Oscar/Certification