Provider Demographics
NPI:1538378971
Name:WILDWOOD PUBLIC SCHOOLS
Entity type:Organization
Organization Name:WILDWOOD PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR OF CST
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-522-1670
Mailing Address - Street 1:4300 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-4625
Mailing Address - Country:US
Mailing Address - Phone:609-522-1670
Mailing Address - Fax:609-522-6226
Practice Address - Street 1:4300 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08260-4625
Practice Address - Country:US
Practice Address - Phone:609-522-1670
Practice Address - Fax:609-522-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6394906Medicaid