Provider Demographics
NPI:1740347582
Name:ROMULUS CENTRAL SCHOOL DISTRICT
Entity type:Organization
Organization Name:ROMULUS CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PPS DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:SHREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-810-0345
Mailing Address - Street 1:5705 STATE RT 96
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:NY
Mailing Address - Zip Code:14541
Mailing Address - Country:US
Mailing Address - Phone:866-810-0345
Mailing Address - Fax:607-869-5961
Practice Address - Street 1:5705 STATE ROUTE 96
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:NY
Practice Address - Zip Code:14541-9551
Practice Address - Country:US
Practice Address - Phone:866-810-0345
Practice Address - Fax:607-869-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01610466Medicaid