1265710974 NPI number — PENNSYLVANIA DISTANCE LEARNING CHARTER SCHOOL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265710974 NPI number — PENNSYLVANIA DISTANCE LEARNING CHARTER SCHOOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENNSYLVANIA DISTANCE LEARNING CHARTER SCHOOL
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:
1265710974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 CORPORATE DRIVE
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
WEXFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-997-3352
Provider Business Mailing Address Fax Number:
888-997-3527

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 CORPORATE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
WEXFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-997-3352
Provider Business Practice Location Address Fax Number:
888-997-3527
Provider Enumeration Date:
07/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ROSSETTI
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
RUTH
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
888-997-3352

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , 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)





Copyright © 2007-2025 www.npivalidator.com