Provider Demographics
NPI:1689611758
Name:SHADE-CENTRAL CITY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:SHADE-CENTRAL CITY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ELEMENTARY PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-754-5021
Mailing Address - Street 1:235 MCGREAGOR AVE
Mailing Address - Street 2:
Mailing Address - City:CAIRNBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:15924-9729
Mailing Address - Country:US
Mailing Address - Phone:814-754-5021
Mailing Address - Fax:814-754-5848
Practice Address - Street 1:235 MCGREAGOR AVE
Practice Address - Street 2:
Practice Address - City:CAIRNBROOK
Practice Address - State:PA
Practice Address - Zip Code:15924-9729
Practice Address - Country:US
Practice Address - Phone:814-754-5021
Practice Address - Fax:814-754-5848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
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
PA0013975100001Medicaid