Provider Demographics
NPI:1568730943
Name:AVERILL PARK CENTRAL SCHOOL DISTRICT
Entity Type:Organization
Organization Name:AVERILL PARK CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-674-7068
Mailing Address - Street 1:146 GETTLE RD
Mailing Address - Street 2:ST # 1
Mailing Address - City:AVERILL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12018-9794
Mailing Address - Country:US
Mailing Address - Phone:518-674-7068
Mailing Address - Fax:518-674-3802
Practice Address - Street 1:146 GETTLE RD
Practice Address - Street 2:ST # 1
Practice Address - City:AVERILL PARK
Practice Address - State:NY
Practice Address - Zip Code:12018-9794
Practice Address - Country:US
Practice Address - Phone:518-674-7068
Practice Address - Fax:518-674-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004339-1251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)