Provider Demographics
NPI:1225094733
Name:BENTON AREA SCHOOL DISTRICT
Entity Type:Organization
Organization Name:BENTON AREA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:ED, D
Authorized Official - Phone:570-925-0922
Mailing Address - Street 1:600 GREEN ACRES RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:PA
Mailing Address - Zip Code:17814-7603
Mailing Address - Country:US
Mailing Address - Phone:570-925-0944
Mailing Address - Fax:570-925-5020
Practice Address - Street 1:600 GREEN ACRES RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:PA
Practice Address - Zip Code:17814-7603
Practice Address - Country:US
Practice Address - Phone:570-925-0944
Practice Address - Fax:570-925-5020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014947650001Medicaid