Provider Demographics
NPI:1912499369
Name:LEHIGH HUMAN SUPPORT SERVICES LLC
Entity type:Organization
Organization Name:LEHIGH HUMAN SUPPORT SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADEWALE
Authorized Official - Middle Name:ALADE
Authorized Official - Last Name:DOSUNMU
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:484-221-8752
Mailing Address - Street 1:1132 HAMILTON ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18101-1024
Mailing Address - Country:US
Mailing Address - Phone:484-221-8752
Mailing Address - Fax:610-819-9096
Practice Address - Street 1:5020 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9188
Practice Address - Country:US
Practice Address - Phone:484-221-8752
Practice Address - Fax:610-619-9096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACER-00129046320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024804850004Medicaid