Provider Demographics
NPI:1588728562
Name:ST. MICHAEL'S SCHOOL
Entity type:Organization
Organization Name:ST. MICHAEL'S SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:M
Authorized Official - Last Name:VARZALY
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:570-388-6155
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-0370
Mailing Address - Country:US
Mailing Address - Phone:570-388-6155
Mailing Address - Fax:
Practice Address - Street 1:HOBAN HEIGHTS, ROUTE 92
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-0370
Practice Address - Country:US
Practice Address - Phone:570-388-6155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children