MEDICARE: NORTHWOOD ACADEMY CS

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	:	1629109798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWOOD ACADEMY CS

Provider Business Mailing Address
First Line	:	4621 CASTOR AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-3024
Country	:	US
Telephone Number	:	215-289-5606
Fax Number	:	215-289-5464

Provider Business Practice Location Address
First Line	:	4621 CASTOR AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-3024
Country	:	US
Telephone Number	:	215-289-5606
Fax Number	:	215-289-5464

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	AMY HOLLISTER
Credential	:
Telephone Number	:	215-289-5606

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	08/22/2020

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