Organization
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF EDUCATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLORIA GREGO (DIRECTOR, PA MEDICAID SCH BASED PRG)
(570) 455-8511
Entity
Organization
Contact information
Practice address
75 KIWANIS BLVD, WEST HAZLETON, PA 18202-1157
(570) 455-8511
(570) 455-4526
Mailing address
75 KIWANIS BLVD, WEST HAZLETON, PA 18202-1157
(570) 455-8511
(570) 455-4526
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000022220002
—
PA
Enumeration date
07/25/2007
Last updated
08/21/2008
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