Provider Demographics
NPI:1295003655
Name:PEMBROKE CSD
Entity Type:Organization
Organization Name:PEMBROKE CSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-599-4525
Mailing Address - Street 1:8750 ALLEGHANY RD
Mailing Address - Street 2:PO BOX 308
Mailing Address - City:CORFU
Mailing Address - State:NY
Mailing Address - Zip Code:14036-9702
Mailing Address - Country:US
Mailing Address - Phone:585-599-4525
Mailing Address - Fax:585-599-4213
Practice Address - Street 1:8750 ALLEGHANY RD
Practice Address - Street 2:
Practice Address - City:CORFU
Practice Address - State:NY
Practice Address - Zip Code:14036-9702
Practice Address - Country:US
Practice Address - Phone:585-599-4525
Practice Address - Fax:585-599-4213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY433545-1251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care