1558494708 NPI number — PENN HARRIS MADISON SCHOOL CORPORATION

Table of content: (NPI 1558494708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558494708 NPI number — PENN HARRIS MADISON SCHOOL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENN HARRIS MADISON SCHOOL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558494708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55900 BITTERSWEET RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISHAWAKA
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46545-7717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-259-7941
Provider Business Mailing Address Fax Number:
574-258-9547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1402 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISHAWAKA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46544-5241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-254-4500
Provider Business Practice Location Address Fax Number:
574-254-4582
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VON RAHL
Authorized Official First Name:
PAM
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR JOINT SERVICES
Authorized Official Telephone Number:
574-254-4528

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , with the licence number:  10047260A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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