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General NPI Number Information
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NPI Number | 1528107869
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Entity Type | Organization
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Legal Business Name | SCHUYLKILL INTERMEDIATE UNIT 29
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 17 MAPLE AVENUE
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City | MARLIN
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State | PA
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Zip | 17951
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Country | US
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Telephone | 570-544-9186
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Fax | 570-544-9189
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Provider Business Mailing Address
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Address Line | 17 MAPLE AVENUE
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City | MARLIN
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State | PA
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Zip | 17951-1300
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Country | US
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Telephone | 570-544-9186
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Fax | 570-544-9189
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. GERALD ACHENBACH
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Credential | PHD
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Telephone | 570-544-9131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 211160
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License Number State | PA
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