Provider Demographics
NPI:1437108693
Name:EDUCATION CENTER AT DT WATSON
Entity Type:Organization
Organization Name:EDUCATION CENTER AT DT WATSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EDUCATION PROGRAM ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRNKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-741-1800
Mailing Address - Street 1:301 CAMP MEETING RD
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143
Mailing Address - Country:US
Mailing Address - Phone:412-749-2308
Mailing Address - Fax:412-741-2454
Practice Address - Street 1:301 CAMP MEETING RD
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143
Practice Address - Country:US
Practice Address - Phone:412-749-2308
Practice Address - Fax:412-741-2454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
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
PA0014758590001Medicaid