Provider Demographics
NPI:1366496713
Name:MILLCREEK TOWNSHIP SCHOOL DISTRICT
Entity Type:Organization
Organization Name:MILLCREEK TOWNSHIP SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PH.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-835-5334
Mailing Address - Street 1:3740 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-2039
Mailing Address - Country:US
Mailing Address - Phone:814-835-5352
Mailing Address - Fax:814-835-5373
Practice Address - Street 1:3740 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-2039
Practice Address - Country:US
Practice Address - Phone:814-835-5352
Practice Address - Fax:814-835-5373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001382110009Medicaid