Provider Demographics
NPI:1114082856
Name:INDIAN RIVER CENTRAL SCHOOL DISTRICT
Entity Type:Organization
Organization Name:INDIAN RIVER CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-642-3441
Mailing Address - Street 1:32735B COUNTY RT 29
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:NY
Mailing Address - Zip Code:13673
Mailing Address - Country:US
Mailing Address - Phone:315-642-3441
Mailing Address - Fax:614-642-3738
Practice Address - Street 1:32735B COUNTY RT 29
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:NY
Practice Address - Zip Code:13673
Practice Address - Country:US
Practice Address - Phone:315-642-3441
Practice Address - Fax:614-642-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
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
NY01423858Medicaid