Provider Demographics
NPI:1023275302
Name:PENNSYLVANIA VIRTUAL CHARTER SCHOOL
Entity type:Organization
Organization Name:PENNSYLVANIA VIRTUAL CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RELATED SERVICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-275-8500
Mailing Address - Street 1:1 W MAIN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-4766
Mailing Address - Country:US
Mailing Address - Phone:610-275-8501
Mailing Address - Fax:610-275-1719
Practice Address - Street 1:1 W MAIN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-4766
Practice Address - Country:US
Practice Address - Phone:610-275-8501
Practice Address - Fax:610-275-1719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019223700001Medicaid