Provider Demographics
NPI:1497803100
Name:EDMONSON COUNTY BOARD OF EDUCATION
Entity Type:Organization
Organization Name:EDMONSON COUNTY BOARD OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOSE DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MR
Authorized Official - First Name:WYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUDILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-597-2101
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42210
Mailing Address - Country:US
Mailing Address - Phone:270-597-2101
Mailing Address - Fax:270-597-2103
Practice Address - Street 1:100 WILDCAT WAY
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42210
Practice Address - Country:US
Practice Address - Phone:270-597-2101
Practice Address - Fax:270-597-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY21031018Medicaid