Provider Demographics
NPI:1134296338
Name:SUGAR VALLEY RURAL CHARTER SCHOOL
Entity Type:Organization
Organization Name:SUGAR VALLEY RURAL CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LATSHA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-725-7822
Mailing Address - Street 1:236 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOGANTON
Mailing Address - State:PA
Mailing Address - Zip Code:17747
Mailing Address - Country:US
Mailing Address - Phone:570-725-7822
Mailing Address - Fax:570-725-7825
Practice Address - Street 1:236 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGANTON
Practice Address - State:PA
Practice Address - Zip Code:17747
Practice Address - Country:US
Practice Address - Phone:570-725-7822
Practice Address - Fax:570-725-7825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018999600001Medicaid