Provider Demographics
NPI:1992832448
Name:BRIDGEWATER WEST WINFIELD CSD
Entity Type:Organization
Organization Name:BRIDGEWATER WEST WINFIELD CSD
Other - Org Name:CENTRAL SCHOOL DISTRICT #1 MOUNT MARKHAM CSB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-822-2826
Mailing Address - Street 1:500 FAIRGROUND ROAD
Mailing Address - Street 2:DISTRICT OFFICE
Mailing Address - City:WEST WINFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13491
Mailing Address - Country:US
Mailing Address - Phone:315-822-2824
Mailing Address - Fax:315-822-6162
Practice Address - Street 1:500 FAIRGROUND ROAD
Practice Address - Street 2:
Practice Address - City:WEST WINFIELD
Practice Address - State:NY
Practice Address - Zip Code:13491
Practice Address - Country:US
Practice Address - Phone:315-822-2824
Practice Address - Fax:315-822-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01367477Medicaid