Provider Demographics
NPI:1629109798
Name:NORTHWOOD ACADEMY CS
Entity Type:Organization
Organization Name:NORTHWOOD ACADEMY CS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-289-5606
Mailing Address - Street 1:4621 CASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-3024
Mailing Address - Country:US
Mailing Address - Phone:215-289-5606
Mailing Address - Fax:215-289-5464
Practice Address - Street 1:4621 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-3024
Practice Address - Country:US
Practice Address - Phone:215-289-5606
Practice Address - Fax:215-289-5464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
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
PA1017121050001Medicaid