Provider Demographics
NPI:1568511251
Name:SULLIVAN WEST CENTRAL SCHOOL DISTRICT
Entity Type:Organization
Organization Name:SULLIVAN WEST CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-482-4610
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:33 SCHOOLHOUSE ROAD
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12748-0308
Mailing Address - Country:US
Mailing Address - Phone:845-482-4610
Mailing Address - Fax:845-482-4620
Practice Address - Street 1:33 SCHOOL HOUSE HILL ROAD
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12764
Practice Address - Country:US
Practice Address - Phone:845-482-4610
Practice Address - Fax:845-482-4620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
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
NY01507946Medicaid