Provider Demographics
NPI:1467596338
Name:BENEDICTINE SCHOOL
Entity Type:Organization
Organization Name:BENEDICTINE SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-634-2112
Mailing Address - Street 1:14299 BENEDICTINE LN
Mailing Address - Street 2:
Mailing Address - City:RIDGELY
Mailing Address - State:MD
Mailing Address - Zip Code:21660-1434
Mailing Address - Country:US
Mailing Address - Phone:410-634-2112
Mailing Address - Fax:410-634-2640
Practice Address - Street 1:14299 BENEDICTINE LN
Practice Address - Street 2:
Practice Address - City:RIDGELY
Practice Address - State:MD
Practice Address - Zip Code:21660-1434
Practice Address - Country:US
Practice Address - Phone:410-634-2112
Practice Address - Fax:410-634-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities