Provider Demographics
NPI:1972660819
Name:LONG LAKE CENTRAL SCHOOL
Entity Type:Organization
Organization Name:LONG LAKE CENTRAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SNIDE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:518-624-2221
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:20 SCHOOL LANE
Mailing Address - City:LONG LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12847-0217
Mailing Address - Country:US
Mailing Address - Phone:518-624-2221
Mailing Address - Fax:518-624-3896
Practice Address - Street 1:20 SCHOOL LANE
Practice Address - Street 2:
Practice Address - City:LONG LAKE
Practice Address - State:NY
Practice Address - Zip Code:12847-0217
Practice Address - Country:US
Practice Address - Phone:518-624-2221
Practice Address - Fax:518-624-3896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01424639Medicaid