Provider Demographics
NPI:1528025061
Name:CONNEAUT SCHOOL DISTRICT
Entity Type:Organization
Organization Name:CONNEAUT SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:CRYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-683-5426
Mailing Address - Street 1:219 W SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:LINESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16424-8609
Mailing Address - Country:US
Mailing Address - Phone:814-683-5900
Mailing Address - Fax:814-683-4127
Practice Address - Street 1:219 W SCHOOL DR
Practice Address - Street 2:
Practice Address - City:LINESVILLE
Practice Address - State:PA
Practice Address - Zip Code:16424-8609
Practice Address - Country:US
Practice Address - Phone:814-683-5900
Practice Address - Fax:814-683-4127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
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
PA0015545220001Medicaid