Healthcare Provider Details

I. General information

NPI: 1578510590
Provider Name (Legal Business Name): PENNCREST SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18741 STATE HWY 198 SUITE 101
SAEGERTOWN PA
16433-4315
US

IV. Provider business mailing address

18741 STATE HWY 198 SUITE 101
SAEGERTOWN PA
16433-4315
US

V. Phone/Fax

Practice location:
  • Phone: 814-337-1626
  • Fax: 814-763-5129
Mailing address:
  • Phone: 814-337-1626
  • Fax: 814-763-5129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LINDA M ASTOR
Title or Position: SPECIAL EDUCATION SUPERVISOR
Credential:
Phone: 814-337-1626