Provider Demographics
NPI:1659438695
Name:WILLSBORO CENTRAL SCHOOL
Entity Type:Organization
Organization Name:WILLSBORO CENTRAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROADWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-963-4456
Mailing Address - Street 1:29 SCHOOL LANE
Mailing Address - Street 2:PO BOX 180
Mailing Address - City:WILLSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12996
Mailing Address - Country:US
Mailing Address - Phone:518-963-4456
Mailing Address - Fax:518-963-7577
Practice Address - Street 1:29 SCHOOL LANE
Practice Address - Street 2:
Practice Address - City:WILLSBORO
Practice Address - State:NY
Practice Address - Zip Code:12996
Practice Address - Country:US
Practice Address - Phone:518-963-4456
Practice Address - Fax:518-963-7577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01469869Medicaid