Provider Demographics
NPI:1366649741
Name:LEHIGH UNIVERSITY CENTENNIAL SCHOOL
Entity type:Organization
Organization Name:LEHIGH UNIVERSITY CENTENNIAL SCHOOL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-266-6500
Mailing Address - Street 1:2196 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-2120
Mailing Address - Country:US
Mailing Address - Phone:610-266-6500
Mailing Address - Fax:610-266-7126
Practice Address - Street 1:2196 AVENUE C
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-2120
Practice Address - Country:US
Practice Address - Phone:610-266-6500
Practice Address - Fax:610-266-7126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA375450251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000049420015Medicaid
PA01455892Medicaid