Provider Demographics
NPI:1891731782
Name:KEYSTONE CENTRAL SCHOOL DISTRICT
Entity Type:Organization
Organization Name:KEYSTONE CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-748-4660
Mailing Address - Street 1:301 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-3815
Mailing Address - Country:US
Mailing Address - Phone:570-748-4660
Mailing Address - Fax:570-748-2026
Practice Address - Street 1:301 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-3815
Practice Address - Country:US
Practice Address - Phone:570-748-4660
Practice Address - Fax:570-748-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
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
PA0014312190001Medicaid