Provider Demographics
NPI:1164620704
Name:COMMONWEALTH CONNECTIONS ACADEMY
Entity Type:Organization
Organization Name:COMMONWEALTH CONNECTIONS ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-651-7200
Mailing Address - Street 1:1426 N 3RD ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17102-1937
Mailing Address - Country:US
Mailing Address - Phone:717-651-7200
Mailing Address - Fax:717-307-3320
Practice Address - Street 1:5010 E TRINDLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3631
Practice Address - Country:US
Practice Address - Phone:717-605-8900
Practice Address - Fax:717-796-9019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016535880001Medicaid