Provider Demographics
NPI:1346371176
Name:FLAGLER COUNTY PUBLIC SCHOOLS
Entity Type:Organization
Organization Name:FLAGLER COUNTY PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID SUPPORT TECHNICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:FERNANAD
Authorized Official - Last Name:VICOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-437-7526
Mailing Address - Street 1:1769 EAST MOODY BOULEVARD, BUILDING 2
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-0755
Mailing Address - Country:US
Mailing Address - Phone:386-437-7526
Mailing Address - Fax:386-586-2388
Practice Address - Street 1:1769 EAST MOODY BOULEVARD, BUILDING 2
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-0755
Practice Address - Country:US
Practice Address - Phone:386-437-7526
Practice Address - Fax:386-586-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)