Provider Demographics
NPI:1174824767
Name:SWEET HOME CENTRAL SCHOOL DISTRICT
Entity Type:Organization
Organization Name:SWEET HOME CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIPE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:716-250-1269
Mailing Address - Street 1:1901 SWEET HOME ROAD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-3399
Mailing Address - Country:US
Mailing Address - Phone:716-250-1269
Mailing Address - Fax:716-250-1296
Practice Address - Street 1:1901 SWEET HOME ROAD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-3399
Practice Address - Country:US
Practice Address - Phone:716-250-1269
Practice Address - Fax:716-250-1296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286382251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01378918Medicaid