Provider Demographics
NPI:1295017770
Name:COLONIAL INTERMEDIATE UNIT 20
Entity Type:Organization
Organization Name:COLONIAL INTERMEDIATE UNIT 20
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTOR DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFEL
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:610-252-5550
Mailing Address - Street 1:6 DANFORTH RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-7820
Mailing Address - Country:US
Mailing Address - Phone:610-252-5550
Mailing Address - Fax:610-515-6457
Practice Address - Street 1:ROUTE 209
Practice Address - Street 2:PLEASANT VALLEY HIGH SCHOOL
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322-9715
Practice Address - Country:US
Practice Address - Phone:610-515-6477
Practice Address - Fax:610-515-6457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA235100261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100754460Medicaid