Organization
BLAST IU17
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN E BRENCHLEY (DIRECTOR OF MANAGEMENT SERVICES)
(570) 673-6001
Entity
Organization
Contact information
Practice address
RR 2 BOX 3364, CANTON, PA 17724-8651
(570) 673-6001
(570) 673-6007
Mailing address
RR 2 BOX 3364, CANTON, PA 17724-8651
(570) 673-6001
(570) 673-6007
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012155910001
—
PA
Enumeration date
12/08/2006
Last updated
08/22/2020
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