Provider Demographics
NPI:1518017094
Name:STRATFORD BOARD OF EDUCATION
Entity Type:Organization
Organization Name:STRATFORD BOARD OF EDUCATION
Other - Org Name:STRATFORD PUBLIC SCHOOLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-385-4210
Mailing Address - Street 1:1000 EAST BROADWAY
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615
Mailing Address - Country:US
Mailing Address - Phone:203-385-4225
Mailing Address - Fax:203-381-2012
Practice Address - Street 1:1000 EAST BROADWAY
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615
Practice Address - Country:US
Practice Address - Phone:203-385-4225
Practice Address - Fax:203-381-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-08-20
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-08-20
Provider Licenses
StateLicense IDTaxonomies
CT004105301251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004105301Medicaid