Provider Demographics
NPI:1508823576
Name:COMMODORE PERRY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:COMMODORE PERRY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER/BOARD SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-253-3255
Mailing Address - Street 1:3002 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:PA
Mailing Address - Zip Code:16130-2628
Mailing Address - Country:US
Mailing Address - Phone:724-253-3255
Mailing Address - Fax:724-253-4691
Practice Address - Street 1:3002 PERRY HWY
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:PA
Practice Address - Zip Code:16130-2628
Practice Address - Country:US
Practice Address - Phone:724-253-3255
Practice Address - Fax:724-253-4691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
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
PA0012285260003Medicaid