Provider Demographics
NPI:1942641832
Name:CAVERNA BOARD OF EDUCATION
Entity Type:Organization
Organization Name:CAVERNA BOARD OF EDUCATION
Other - Org Name:CAVERNA IND. SCHOOLS
Other - Org Type:Other Name
Authorized Official - Title/Position:DOSE
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-773-2530
Mailing Address - Street 1:1102 N DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:CAVE CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42127-9516
Mailing Address - Country:US
Mailing Address - Phone:270-773-2530
Mailing Address - Fax:270-773-2524
Practice Address - Street 1:1102 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:KY
Practice Address - Zip Code:42127-9516
Practice Address - Country:US
Practice Address - Phone:270-773-2530
Practice Address - Fax:270-773-2524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY21000260Medicaid