Provider Demographics
NPI:1205991007
Name:MINERVA CENTRAL SCHOOL DISTRICT
Entity type:Organization
Organization Name:MINERVA CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-251-2000
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:OLMSTEDVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12857-0039
Mailing Address - Country:US
Mailing Address - Phone:518-251-2000
Mailing Address - Fax:518-251-2395
Practice Address - Street 1:1466 COUNTY RTE. 29
Practice Address - Street 2:
Practice Address - City:OLMSTEDVILLE
Practice Address - State:NY
Practice Address - Zip Code:12857
Practice Address - Country:US
Practice Address - Phone:518-251-2000
Practice Address - Fax:518-251-2395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
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
NY01382347Medicaid