Provider Demographics
NPI:1073786323
Name:MT. EPHRAIM PUBLIC SCHOOL
Entity Type:Organization
Organization Name:MT. EPHRAIM PUBLIC SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR / BRD SECRET
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-931-1634
Mailing Address - Street 1:125 S BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:MOUNT EPHRAIM
Mailing Address - State:NJ
Mailing Address - Zip Code:08059-1721
Mailing Address - Country:US
Mailing Address - Phone:856-931-1634
Mailing Address - Fax:856-931-0202
Practice Address - Street 1:125 S BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:MOUNT EPHRAIM
Practice Address - State:NJ
Practice Address - Zip Code:08059-1721
Practice Address - Country:US
Practice Address - Phone:856-931-1634
Practice Address - Fax:856-931-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0138452Medicaid