Provider Demographics
NPI:1568428597
Name:CHESTNUT RIDGE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:CHESTNUT RIDGE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:OTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:814-839-4195
Mailing Address - Street 1:3281 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FISHERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15539-9843
Mailing Address - Country:US
Mailing Address - Phone:814-839-4195
Mailing Address - Fax:814-839-9137
Practice Address - Street 1:3281 VALLEY RD
Practice Address - Street 2:
Practice Address - City:FISHERTOWN
Practice Address - State:PA
Practice Address - Zip Code:15539-9843
Practice Address - Country:US
Practice Address - Phone:814-839-4195
Practice Address - Fax:814-839-9137
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
PA0013004400001Medicaid