Provider Demographics
NPI:1336322031
Name:SCHUYLKILL COUNTY AVTS
Entity Type:Organization
Organization Name:SCHUYLKILL COUNTY AVTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:5705-440-9131
Mailing Address - Street 1:17 MAPLE AVE
Mailing Address - Street 2:PO BOX 130
Mailing Address - City:MARLIN
Mailing Address - State:PA
Mailing Address - Zip Code:17951-0130
Mailing Address - Country:US
Mailing Address - Phone:570-544-9131
Mailing Address - Fax:570-544-6412
Practice Address - Street 1:17 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MARLIN
Practice Address - State:PA
Practice Address - Zip Code:17951-0130
Practice Address - Country:US
Practice Address - Phone:570-544-9131
Practice Address - Fax:570-544-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019607110001Medicaid