Provider Demographics
NPI:1639213473
Name:WYOMING VALLEY CHILDRENS ASSOCIATION
Entity Type:Organization
Organization Name:WYOMING VALLEY CHILDRENS ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-714-1246
Mailing Address - Street 1:1133 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4003
Mailing Address - Country:US
Mailing Address - Phone:570-714-1246
Mailing Address - Fax:570-714-1249
Practice Address - Street 1:1133 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4003
Practice Address - Country:US
Practice Address - Phone:570-714-1246
Practice Address - Fax:570-714-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000034800004Medicaid