Provider Demographics
NPI:1912940669
Name:POCONO MOUNTAIN SCHOOL DISTRICT
Entity Type:Organization
Organization Name:POCONO MOUNTAIN SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:V
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-839-7121
Mailing Address - Street 1:POCONO MOUNTAIN SCHOOL RD
Mailing Address - Street 2:PO BOX 200
Mailing Address - City:SWIFTWATER
Mailing Address - State:PA
Mailing Address - Zip Code:18370-0200
Mailing Address - Country:US
Mailing Address - Phone:570-839-7121
Mailing Address - Fax:570-895-4522
Practice Address - Street 1:POCONO MOUNTAIN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SWIFTWATER
Practice Address - State:PA
Practice Address - Zip Code:18370-0200
Practice Address - Country:US
Practice Address - Phone:570-839-7121
Practice Address - Fax:570-895-4522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
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
PA0014451610001Medicaid