Provider Demographics
NPI:1447389721
Name:ELK LAKE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:ELK LAKE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-278-1106
Mailing Address - Street 1:2380 ELK LAKE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18844-7710
Mailing Address - Country:US
Mailing Address - Phone:570-278-1106
Mailing Address - Fax:570-278-4838
Practice Address - Street 1:2380 ELK LAKE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:PA
Practice Address - Zip Code:18844-7710
Practice Address - Country:US
Practice Address - Phone:570-278-1106
Practice Address - Fax:570-278-4838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015024280001Medicaid