Provider Demographics
NPI:1265563712
Name:BRADFORD SCHOOL DISTRICT
Entity type:Organization
Organization Name:BRADFORD SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:H
Authorized Official - Last Name:WOLVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-583-4616
Mailing Address - Street 1:2820 STATE ROUTE 226
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14815-9624
Mailing Address - Country:US
Mailing Address - Phone:607-583-4616
Mailing Address - Fax:607-583-4013
Practice Address - Street 1:2820 STATE ROUTE 226
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:NY
Practice Address - Zip Code:14815-9624
Practice Address - Country:US
Practice Address - Phone:607-583-4616
Practice Address - Fax:607-583-4013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01411729Medicaid