Provider Demographics
NPI:1023044393
Name:SUSQUEHANNA COMMUNITY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:SUSQUEHANNA COMMUNITY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-853-4921
Mailing Address - Street 1:RR 3 BOX 5A
Mailing Address - Street 2:TURNPIKE STREET
Mailing Address - City:SUSQUEHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18847-9504
Mailing Address - Country:US
Mailing Address - Phone:570-853-4921
Mailing Address - Fax:570-853-3768
Practice Address - Street 1:RR 3 BOX 5A
Practice Address - Street 2:TURNPIKE STREET
Practice Address - City:SUSQUEHANNA
Practice Address - State:PA
Practice Address - Zip Code:18847-9504
Practice Address - Country:US
Practice Address - Phone:570-853-4921
Practice Address - Fax:570-853-3768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016106120001Medicaid