Provider Demographics
NPI:1669541553
Name:AVON GROVE CHARTER SCHOOL
Entity type:Organization
Organization Name:AVON GROVE CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO/HEAD OF SCHOOL
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-667-5001
Mailing Address - Street 1:110 E STATE ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390
Mailing Address - Country:US
Mailing Address - Phone:484-667-5001
Mailing Address - Fax:610-869-5892
Practice Address - Street 1:110 E STATE ROAD
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390
Practice Address - Country:US
Practice Address - Phone:484-667-5001
Practice Address - Fax:610-869-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016792160001Medicaid