Provider Demographics
NPI:1679608673
Name:ELLICOTTVILLE CENTRAL SCHOOL
Entity type:Organization
Organization Name:ELLICOTTVILLE CENTRAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-699-2368
Mailing Address - Street 1:5873 ROUTE 219 S
Mailing Address - Street 2:
Mailing Address - City:ELLICOTTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14731-9720
Mailing Address - Country:US
Mailing Address - Phone:716-699-2316
Mailing Address - Fax:716-699-2350
Practice Address - Street 1:5873 ROUTE 219 S
Practice Address - Street 2:
Practice Address - City:ELLICOTTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14731-9720
Practice Address - Country:US
Practice Address - Phone:716-699-2316
Practice Address - Fax:716-699-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01477123Medicaid