Provider Demographics
NPI:1518181445
Name:SCHOOL BOARD OF BRADFORD CO FL
Entity Type:Organization
Organization Name:SCHOOL BOARD OF BRADFORD CO FL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID FINANCE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:T
Authorized Official - Last Name:PRIEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-966-6815
Mailing Address - Street 1:611 N ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-2434
Mailing Address - Country:US
Mailing Address - Phone:904-966-6815
Mailing Address - Fax:904-966-6818
Practice Address - Street 1:611 N ORANGE ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-2434
Practice Address - Country:US
Practice Address - Phone:904-966-6815
Practice Address - Fax:904-966-6818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)