Provider Demographics
NPI:1407806433
Name:WORDSWORTH ACADEMY
Entity type:Organization
Organization Name:WORDSWORTH ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LACKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-643-5400
Mailing Address - Street 1:2101 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2912
Mailing Address - Country:US
Mailing Address - Phone:215-643-5400
Mailing Address - Fax:
Practice Address - Street 1:2101 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2912
Practice Address - Country:US
Practice Address - Phone:215-643-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007283610046Medicaid