Provider Demographics
NPI:1578199659
Name:SILVER SPRINGS - MARTIN LUTHER SCHOOL
Entity Type:Organization
Organization Name:SILVER SPRINGS - MARTIN LUTHER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF PROGRAM INTEGRITY
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FENSTERMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-525-5400
Mailing Address - Street 1:452 S ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:452 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1136
Practice Address - Country:US
Practice Address - Phone:610-525-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007760280030Medicaid