Provider Demographics
NPI:1780013318
Name:LOURDES HOSPITAL
Entity Type:Organization
Organization Name:LOURDES HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:TIFFANY
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-760-1280
Mailing Address - Street 1:1496 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:PA
Mailing Address - Zip Code:18821-9516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1496 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:PA
Practice Address - Zip Code:18821-9516
Practice Address - Country:US
Practice Address - Phone:607-760-1280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY637453-1385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child