Provider Demographics
NPI:1104098300
Name:LIGONIER VALLEY LEARNING CENTER, INC
Entity type:Organization
Organization Name:LIGONIER VALLEY LEARNING CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FAULK
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CRC, LPC
Authorized Official - Phone:724-238-0355
Mailing Address - Street 1:109 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-1214
Mailing Address - Country:US
Mailing Address - Phone:724-238-0355
Mailing Address - Fax:724-238-0352
Practice Address - Street 1:117 JUNIPER LN
Practice Address - Street 2:LIGONIER VALLEY LEARNING CENTER
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-9727
Practice Address - Country:US
Practice Address - Phone:724-238-5556
Practice Address - Fax:724-238-9533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001348580007Medicaid