Provider Demographics
NPI:1760533780
Name:CANASTOTA CENTRAL SCHOOL
Entity Type:Organization
Organization Name:CANASTOTA CENTRAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINDENT OF SCHOOLS
Authorized Official - Prefix:MS
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:CAS
Authorized Official - Phone:315-697-2025
Mailing Address - Street 1:120 ROBERTS ST
Mailing Address - Street 2:
Mailing Address - City:CANASTOTA
Mailing Address - State:NY
Mailing Address - Zip Code:13032-1127
Mailing Address - Country:US
Mailing Address - Phone:315-697-2025
Mailing Address - Fax:315-697-6368
Practice Address - Street 1:120 ROBERTS ST
Practice Address - Street 2:
Practice Address - City:CANASTOTA
Practice Address - State:NY
Practice Address - Zip Code:13032-1127
Practice Address - Country:US
Practice Address - Phone:315-697-2025
Practice Address - Fax:315-697-6368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01390707Medicaid