Provider Demographics
NPI:1457317968
Name:BERLIN BROTHERSVALLEY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:BERLIN BROTHERSVALLEY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:GINDLESPERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-267-4621
Mailing Address - Street 1:1025 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15530-1426
Mailing Address - Country:US
Mailing Address - Phone:814-267-4621
Mailing Address - Fax:814-267-6060
Practice Address - Street 1:1025 MAIN ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:PA
Practice Address - Zip Code:15530-1426
Practice Address - Country:US
Practice Address - Phone:814-267-4621
Practice Address - Fax:814-267-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013017420001Medicaid