Provider Demographics
NPI:1538125737
Name:BRENTWOOD BOROUGH SCHOOL DISTRICT
Entity Type:Organization
Organization Name:BRENTWOOD BOROUGH SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:DUFALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-881-2227
Mailing Address - Street 1:3601 BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-3117
Mailing Address - Country:US
Mailing Address - Phone:412-881-2227
Mailing Address - Fax:412-881-1640
Practice Address - Street 1:3601 BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-3117
Practice Address - Country:US
Practice Address - Phone:412-881-2227
Practice Address - Fax:412-881-1640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
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
PA0014590870001Medicaid