MEDICARE: COMMODORE PERRY SCHOOL DISTRICT

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)		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508823576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMODORE PERRY SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	3002 PERRY HWY
Second Line	:
City	:	HADLEY
State	:	PA
Zip	:	16130-2628
Country	:	US
Telephone Number	:	724-253-3255
Fax Number	:	724-253-4691

Provider Business Practice Location Address
First Line	:	3002 PERRY HWY
Second Line	:
City	:	HADLEY
State	:	PA
Zip	:	16130-2628
Country	:	US
Telephone Number	:	724-253-3255
Fax Number	:	724-253-4691

Authorized Official
Title or Position	:	BUSINESS MANAGER/BOARD SECRETARY
Name	:	MRS. ROBIN S JOHNSON
Credential	:
Telephone Number	:	724-253-3255

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	08/22/2020

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Directions to “COMMODORE PERRY SCHOOL DISTRICT ” Practice Location

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