Provider Demographics
NPI:1609933423
Name:GRANVILLE CENTRAL SCHOOL DISTRICT
Entity Type:Organization
Organization Name:GRANVILLE CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-642-1051
Mailing Address - Street 1:58 QUAKER STREET
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12832
Mailing Address - Country:US
Mailing Address - Phone:518-642-1051
Mailing Address - Fax:518-642-2491
Practice Address - Street 1:58 QUAKER ST
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:NY
Practice Address - Zip Code:12832
Practice Address - Country:US
Practice Address - Phone:518-642-1051
Practice Address - Fax:518-642-2491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01379735Medicaid