Provider Demographics
NPI:1265432165
Name:COUNTRY MEADOWS OF NORTHAMPTON ASSOCIATES, LP
Entity type:Organization
Organization Name:COUNTRY MEADOWS OF NORTHAMPTON ASSOCIATES, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP- FINANCE, ACCOUNTING, INFOR SRVS
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIZAK
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:717-533-2474
Mailing Address - Street 1:830 CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2007
Mailing Address - Country:US
Mailing Address - Phone:717-533-2474
Mailing Address - Fax:717-533-1014
Practice Address - Street 1:4025 GREEN POND RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-9662
Practice Address - Country:US
Practice Address - Phone:610-882-4110
Practice Address - Fax:610-882-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA096802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026761200001Medicaid
PA396053Medicare PIN