Provider Demographics
NPI:1578604138
Name:EVANS-BRANT CENTRAL SCHOOL DISTRICT
Entity Type:Organization
Organization Name:EVANS-BRANT CENTRAL SCHOOL DISTRICT
Other - Org Name:LAKE SHORE CENTRAL SCHOOLS
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:PACOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-926-2221
Mailing Address - Street 1:959 BEACH ROAD
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:NY
Mailing Address - Zip Code:14006-9782
Mailing Address - Country:US
Mailing Address - Phone:716-926-2221
Mailing Address - Fax:716-549-6228
Practice Address - Street 1:959 BEACH ROAD
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:NY
Practice Address - Zip Code:14006-9782
Practice Address - Country:US
Practice Address - Phone:716-926-2221
Practice Address - Fax:716-549-6228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01367404Medicaid