1043498272 NPI number — COLONIAL IU 20

Table of content: (NPI 1043498272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043498272 NPI number — COLONIAL IU 20

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLONIAL IU 20
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:
1043498272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 DANFORTH DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18045-7899
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-252-5550
Provider Business Mailing Address Fax Number:
610-515-6590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PEN ARGYL AREA HIGH SCHOOL
Provider Second Line Business Practice Location Address:
501 WEST LAUREL AVE
Provider Business Practice Location Address City Name:
PEN ARGYL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-515-6440
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WOLFEL
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
S
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
610-252-5550

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X , with the licence number:  235100 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100754460 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com