Provider Demographics
NPI:1578511333
Name:CENTRAL SUSQUEHANNA INTERMEDIATE UNIT
Entity Type:Organization
Organization Name:CENTRAL SUSQUEHANNA INTERMEDIATE UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:WITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-523-1155
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-0213
Mailing Address - Country:US
Mailing Address - Phone:570-523-1155
Mailing Address - Fax:570-523-0092
Practice Address - Street 1:90 LAWTON LN
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847-9756
Practice Address - Country:US
Practice Address - Phone:570-523-1155
Practice Address - Fax:570-523-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
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
PA0012197050001Medicaid