Provider Demographics
NPI:1467591974
Name:CARSON VALLEY CHILDREN'S AID
Entity Type:Organization
Organization Name:CARSON VALLEY CHILDREN'S AID
Other - Org Name:CARSON VALLEY SCHOOL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEZGODA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:215-233-1960
Mailing Address - Street 1:1419 BETHLEHEM PIKE
Mailing Address - Street 2:
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-1904
Mailing Address - Country:US
Mailing Address - Phone:215-233-1960
Mailing Address - Fax:215-233-9151
Practice Address - Street 1:1419 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1904
Practice Address - Country:US
Practice Address - Phone:215-233-1960
Practice Address - Fax:215-233-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1002909500008323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100290950002Medicaid
PA1002909500008Medicaid