Provider Demographics
NPI:1164576419
Name:WAVERLY CENTRAL SCHOOL DISTRICT
Entity Type:Organization
Organization Name:WAVERLY CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-565-2841
Mailing Address - Street 1:15 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NY
Mailing Address - Zip Code:14892-1207
Mailing Address - Country:US
Mailing Address - Phone:607-565-2841
Mailing Address - Fax:607-565-4997
Practice Address - Street 1:15 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NY
Practice Address - Zip Code:14892-1207
Practice Address - Country:US
Practice Address - Phone:607-565-2841
Practice Address - Fax:607-565-4997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01388545Medicaid