Provider Demographics
NPI:1225832306
Name:COLONIAL INTERMEDIATE UNIT #20
Entity type:Organization
Organization Name:COLONIAL INTERMEDIATE UNIT #20
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST MGMT TO MEDICAL BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSIBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-515-6439
Mailing Address - Street 1:6 DANFORTH DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-7820
Mailing Address - Country:US
Mailing Address - Phone:610-252-5550
Mailing Address - Fax:610-252-5740
Practice Address - Street 1:180 PANTHER LN
Practice Address - Street 2:
Practice Address - City:POCONO SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18346-7724
Practice Address - Country:US
Practice Address - Phone:610-515-6439
Practice Address - Fax:484-291-4135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007544600Medicaid