Provider Demographics
NPI:1699305375
Name:LCH HEALTH AND COMMUNITY SERVICES
Entity type:Organization
Organization Name:LCH HEALTH AND COMMUNITY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE & ACCREDITATION ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAULFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-444-7550
Mailing Address - Street 1:731 W CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2419
Mailing Address - Country:US
Mailing Address - Phone:610-444-7550
Mailing Address - Fax:610-444-4656
Practice Address - Street 1:105 VINEYARD WAY STE 103
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-8849
Practice Address - Country:US
Practice Address - Phone:610-444-7550
Practice Address - Fax:610-444-4656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100752680-0012Medicaid