Provider Demographics
NPI:1124161526
Name:SOUTHERN COLUMBIA SCHOOL DISTRICT
Entity type:Organization
Organization Name:SOUTHERN COLUMBIA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPEC. EDUC.
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:MEHALICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-356-3510
Mailing Address - Street 1:800 SOUTHERN DR
Mailing Address - Street 2:
Mailing Address - City:CATAWISSA
Mailing Address - State:PA
Mailing Address - Zip Code:17820-8410
Mailing Address - Country:US
Mailing Address - Phone:570-356-2331
Mailing Address - Fax:570-356-2892
Practice Address - Street 1:800 SOUTHERN DR
Practice Address - Street 2:
Practice Address - City:CATAWISSA
Practice Address - State:PA
Practice Address - Zip Code:17820-8410
Practice Address - Country:US
Practice Address - Phone:570-356-2331
Practice Address - Fax:570-356-2892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
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
PA0013020420001Medicaid