Provider Demographics
NPI:1972932580
Name:VILLAGE CHARTER SCHOOL
Entity type:Organization
Organization Name:VILLAGE CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:TWISDALE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:609-695-0110
Mailing Address - Street 1:101 SULLIVAN WAY
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3425
Mailing Address - Country:US
Mailing Address - Phone:609-695-0110
Mailing Address - Fax:609-695-1880
Practice Address - Street 1:101 SULLIVAN WAY
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3425
Practice Address - Country:US
Practice Address - Phone:609-695-0110
Practice Address - Fax:609-695-1880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty