Healthcare Provider Details

I. General information

NPI: 1467407791
Provider Name (Legal Business Name): OLD FORGE SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MELMORE ST
OLD FORGE PA
18518-1647
US

IV. Provider business mailing address

401 MELMORE ST
OLD FORGE PA
18518-1647
US

V. Phone/Fax

Practice location:
  • Phone: 717-457-8391
  • Fax:
Mailing address:
  • Phone: 717-457-8391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0014981470001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DR. GENE A CAMONI
Title or Position: SUPERINTENDENT
Credential: ED.D.
Phone: 570-457-6721