Provider Demographics
NPI:1205983723
Name:SCHROON LAKE CENTRAL SCHOOL
Entity type:Organization
Organization Name:SCHROON LAKE CENTRAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BONNEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-532-7164
Mailing Address - Street 1:1125 U.S. ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:SCHROON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12870-0338
Mailing Address - Country:US
Mailing Address - Phone:518-532-7164
Mailing Address - Fax:518-532-0284
Practice Address - Street 1:1125 U.S. ROUTE 9
Practice Address - Street 2:
Practice Address - City:SCHROON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12870-0338
Practice Address - Country:US
Practice Address - Phone:518-532-7164
Practice Address - Fax:518-532-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01483985Medicaid