Provider Demographics
NPI:1508816240
Name:FORT LEBOEUF SCHOOL DISTRICT
Entity Type:Organization
Organization Name:FORT LEBOEUF SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCESS COORDINATOR/ADMIN. ASST.
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-796-2638
Mailing Address - Street 1:34 E 9TH ST
Mailing Address - Street 2:PO BOX 810
Mailing Address - City:WATERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16441-7826
Mailing Address - Country:US
Mailing Address - Phone:814-796-2638
Mailing Address - Fax:814-796-3358
Practice Address - Street 1:34 E 9TH ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:PA
Practice Address - Zip Code:16441-7826
Practice Address - Country:US
Practice Address - Phone:814-796-2638
Practice Address - Fax:814-796-3358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
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
PA1001382580002Medicaid