Provider Demographics
NPI:1124127907
Name:SUSQUEHANNA TOWNSHIP SCHOOL DISTRICT
Entity type:Organization
Organization Name:SUSQUEHANNA TOWNSHIP SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-657-5100
Mailing Address - Street 1:3550 ELMERTON AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-1131
Mailing Address - Country:US
Mailing Address - Phone:717-657-5100
Mailing Address - Fax:717-657-2919
Practice Address - Street 1:3550 ELMERTON AVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-1131
Practice Address - Country:US
Practice Address - Phone:717-657-5100
Practice Address - Fax:717-657-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019020270001Medicaid