Provider Demographics
NPI:1891822284
Name:ALBRIGHT LIFE
Entity Type:Organization
Organization Name:ALBRIGHT LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS FOR ALBRIGHT CARE
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-524-9930
Mailing Address - Street 1:90 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-6307
Mailing Address - Country:US
Mailing Address - Phone:570-524-9930
Mailing Address - Fax:570-524-9068
Practice Address - Street 1:417 W FREDERICK ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2804
Practice Address - Country:US
Practice Address - Phone:570-524-9930
Practice Address - Fax:570-524-9068
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBRIGHT CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-27
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA20-5134697251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization