Provider Demographics
NPI:1316003023
Name:COPENHAGEN CENTRAL SCHOOL
Entity Type:Organization
Organization Name:COPENHAGEN CENTRAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MUNN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MS, CAS
Authorized Official - Phone:315-688-4411
Mailing Address - Street 1:PO BOX 30
Mailing Address - Street 2:
Mailing Address - City:COPENHAGEN
Mailing Address - State:NY
Mailing Address - Zip Code:13626-0030
Mailing Address - Country:US
Mailing Address - Phone:315-688-4411
Mailing Address - Fax:315-688-2001
Practice Address - Street 1:3020 MECHANIC STREET
Practice Address - Street 2:
Practice Address - City:COPENHAGEN
Practice Address - State:NY
Practice Address - Zip Code:13626
Practice Address - Country:US
Practice Address - Phone:315-688-4411
Practice Address - Fax:315-688-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01724478Medicaid