Provider Demographics
NPI:1366609828
Name:PHILADELPHIA MONTESSORI CHARTER SCHOOL
Entity type:Organization
Organization Name:PHILADELPHIA MONTESSORI CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DZURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-365-4011
Mailing Address - Street 1:2227 ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-1009
Mailing Address - Country:US
Mailing Address - Phone:215-365-4011
Mailing Address - Fax:
Practice Address - Street 1:2227 ISLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-1009
Practice Address - Country:US
Practice Address - Phone:215-365-4011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015507960001Medicaid