Provider Demographics
NPI:1699829754
Name:PENN YAN CENTRAL SCHOOL
Entity Type:Organization
Organization Name:PENN YAN CENTRAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. TO DIR. OF STUDENT SUPPORT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-536-3399
Mailing Address - Street 1:1 SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1081
Mailing Address - Country:US
Mailing Address - Phone:315-536-3399
Mailing Address - Fax:315-536-2514
Practice Address - Street 1:1 SCHOOL DR
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1081
Practice Address - Country:US
Practice Address - Phone:315-536-3399
Practice Address - Fax:315-536-2514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
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
NY01388403Medicaid