Provider Demographics
NPI:1245344274
Name:COVINGTON CITY PUBLIC SCHOOLS SMIHLE PROGRAM
Entity type:Organization
Organization Name:COVINGTON CITY PUBLIC SCHOOLS SMIHLE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:DOWNER
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:540-863-1736
Mailing Address - Street 1:210 MOUNTAINEER DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-6331
Mailing Address - Country:US
Mailing Address - Phone:540-863-1736
Mailing Address - Fax:
Practice Address - Street 1:210 MOUNTAINEER DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-6331
Practice Address - Country:US
Practice Address - Phone:540-863-1736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004980425Medicaid