Provider Demographics
NPI:1902825896
Name:BLUE MOUNTAIN HOSPITAL
Entity Type:Organization
Organization Name:BLUE MOUNTAIN HOSPITAL
Other - Org Name:BLUE MOUNTAIN HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-377-7003
Mailing Address - Street 1:211 NORTH 12TH STREET
Mailing Address - Street 2:FINANCE OFFICE
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-1596
Mailing Address - Country:US
Mailing Address - Phone:610-377-7003
Mailing Address - Fax:610-377-4758
Practice Address - Street 1:800 MAHONING ST SUITE A
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1246
Practice Address - Country:US
Practice Address - Phone:610-377-7157
Practice Address - Fax:610-377-7926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA710505251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1004958310012Medicaid
PA1004958310012Medicaid