Provider Demographics
NPI:1609921501
Name:EAST BLOOMFIELD CENTRAL SCHOOL
Entity Type:Organization
Organization Name:EAST BLOOMFIELD CENTRAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PPS
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATERI
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-657-6121
Mailing Address - Street 1:45 MAPLE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14469-9394
Mailing Address - Country:US
Mailing Address - Phone:585-657-6121
Mailing Address - Fax:585-657-6060
Practice Address - Street 1:45 MAPLE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BLOOMFIELD
Practice Address - State:NY
Practice Address - Zip Code:14469-9394
Practice Address - Country:US
Practice Address - Phone:585-657-6121
Practice Address - Fax:585-657-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01686626Medicaid