Provider Demographics
NPI:1477610335
Name:KEENE CENTRAL SCHOOL
Entity Type:Organization
Organization Name:KEENE CENTRAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT CONTACT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:STURGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-576-4555
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:KEENE VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12943-0067
Mailing Address - Country:US
Mailing Address - Phone:518-576-4555
Mailing Address - Fax:518-576-4555
Practice Address - Street 1:33 MARKET STREET
Practice Address - Street 2:
Practice Address - City:KEENE VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12943
Practice Address - Country:US
Practice Address - Phone:518-576-4555
Practice Address - Fax:518-576-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
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
NY01366921Medicaid