Provider Demographics
NPI:1871641464
Name:SALEM CENTRAL SCHOOL
Entity Type:Organization
Organization Name:SALEM CENTRAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PHANEUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-854-7600
Mailing Address - Street 1:41 E BROADWAY
Mailing Address - Street 2:PO BOX 517
Mailing Address - City:SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:12865-3100
Mailing Address - Country:US
Mailing Address - Phone:518-854-7600
Mailing Address - Fax:518-854-3957
Practice Address - Street 1:41 E BROADWAY
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NY
Practice Address - Zip Code:12865-3100
Practice Address - Country:US
Practice Address - Phone:518-854-7600
Practice Address - Fax:518-854-3957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
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
NY01383559Medicaid