Healthcare Provider Details

I. General information

NPI: 1407806672
Provider Name (Legal Business Name): SOUDERTON CHARTER SCHOOL COLLABORATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E BROAD ST
SOUDERTON PA
18964-1276
US

IV. Provider business mailing address

110 E BROAD ST
SOUDERTON PA
18964-1276
US

V. Phone/Fax

Practice location:
  • Phone: 215-721-4560
  • Fax: 215-721-4071
Mailing address:
  • Phone: 215-721-4560
  • Fax: 215-721-4071

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: MS. WENDY D ORMSBY
Title or Position: DIRECTOR ORGANIZATIONAL DUPT.
Credential:
Phone: 215-721-4560