Provider Demographics
NPI:1699827584
Name:PAVILION CENTRAL SCHOOL
Entity Type:Organization
Organization Name:PAVILION CENTRAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL CLERK
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-584-3115
Mailing Address - Street 1:7014 BIG TREE RD
Mailing Address - Street 2:
Mailing Address - City:PAVILION
Mailing Address - State:NY
Mailing Address - Zip Code:14525-9138
Mailing Address - Country:US
Mailing Address - Phone:585-584-3115
Mailing Address - Fax:585-584-3421
Practice Address - Street 1:7014 BIG TREE RD
Practice Address - Street 2:
Practice Address - City:PAVILION
Practice Address - State:NY
Practice Address - Zip Code:14525-9138
Practice Address - Country:US
Practice Address - Phone:585-584-3115
Practice Address - Fax:585-584-3421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY181201Medicaid