Provider Demographics
NPI:1760604060
Name:GREATER NANTICOKE AREA SCHOOL DISTRICT
Entity Type:Organization
Organization Name:GREATER NANTICOKE AREA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCESS PROGRAM
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KATRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-735-1701
Mailing Address - Street 1:425 KOSCIUSZKO ST.
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-2698
Mailing Address - Country:US
Mailing Address - Phone:570-735-1701
Mailing Address - Fax:570-733-1003
Practice Address - Street 1:425 KOSCIUSZKO ST.
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-2698
Practice Address - Country:US
Practice Address - Phone:570-735-1701
Practice Address - Fax:570-733-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
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
PA0014488700001Medicaid