Provider Demographics
NPI:1376600593
Name:NORTH ROSE-WOLCOTT CSD
Entity Type:Organization
Organization Name:NORTH ROSE-WOLCOTT CSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR OF PUPIL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-587-9937
Mailing Address - Street 1:11669 SALTER COLVIN RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:NY
Mailing Address - Zip Code:14590-9376
Mailing Address - Country:US
Mailing Address - Phone:315-587-9937
Mailing Address - Fax:315-587-9925
Practice Address - Street 1:11669 SALTER COLVIN RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:NY
Practice Address - Zip Code:14590-9376
Practice Address - Country:US
Practice Address - Phone:315-587-9937
Practice Address - Fax:315-587-9925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01416408Medicaid