Provider Demographics
NPI:1881642619
Name:NORTHEASTERN EDUCATIONAL INTERMEDIATE UNIT
Entity Type:Organization
Organization Name:NORTHEASTERN EDUCATIONAL INTERMEDIATE UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAMANNA
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:570-876-9200
Mailing Address - Street 1:1200 LINE ST
Mailing Address - Street 2:
Mailing Address - City:ARCHBALD
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1918
Mailing Address - Country:US
Mailing Address - Phone:570-876-9200
Mailing Address - Fax:570-876-8662
Practice Address - Street 1:1200 LINE ST
Practice Address - Street 2:
Practice Address - City:ARCHBALD
Practice Address - State:PA
Practice Address - Zip Code:18403-1918
Practice Address - Country:US
Practice Address - Phone:570-876-9200
Practice Address - Fax:570-876-8662
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
PA0013060230001Medicaid