Provider Demographics
NPI:1508915737
Name:WEEDSPORT CENTRAL SCHOOL DISTRICT
Entity Type:Organization
Organization Name:WEEDSPORT CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL PROGRAMS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEFAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-834-6752
Mailing Address - Street 1:2821 E BRUTUS STREET RD
Mailing Address - Street 2:
Mailing Address - City:WEEDSPORT
Mailing Address - State:NY
Mailing Address - Zip Code:13166-8721
Mailing Address - Country:US
Mailing Address - Phone:315-834-6752
Mailing Address - Fax:315-834-6712
Practice Address - Street 1:2821 E BRUTUS STREET RD
Practice Address - Street 2:
Practice Address - City:WEEDSPORT
Practice Address - State:NY
Practice Address - Zip Code:13166-8721
Practice Address - Country:US
Practice Address - Phone:315-834-6752
Practice Address - Fax:315-834-6712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
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
NY01383953Medicaid