Provider Demographics
NPI:1780953257
Name:INDIAN RIVER CENTRAL SCHOOL
Entity type:Organization
Organization Name:INDIAN RIVER CENTRAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STOFFEL
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:315-629-4331
Mailing Address - Street 1:8442 S MAIN STREET
Mailing Address - Street 2:EVANS MILLS PRIMARY SCHOOL
Mailing Address - City:EVANS MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13637
Mailing Address - Country:US
Mailing Address - Phone:315-629-4331
Mailing Address - Fax:315-629-5257
Practice Address - Street 1:8442 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:EVANS MILLS
Practice Address - State:NY
Practice Address - Zip Code:13637
Practice Address - Country:US
Practice Address - Phone:315-629-4331
Practice Address - Fax:315-629-5257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305177.1251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01423858Medicaid