MEDICARE: PROPEL CHARTER SCHOOL - HAZELWOOD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1124617691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROPEL CHARTER SCHOOL - HAZELWOOD

Provider Business Mailing Address
First Line	:	3447 E CARSON ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15203-2150
Country	:	US
Telephone Number	:	412-325-7305
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 GLENWOOD AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15207-1847
Country	:	US
Telephone Number	:	123-250-4924
Fax Number	:	412-325-0494

Authorized Official
Title or Position	:	CFO
Name	:	BETH WRIGHT
Credential	:
Telephone Number	:	412-325-7305

Provider Enumeration Date	:	01/11/2021
Last Update Date	:	02/17/2021

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