Healthcare Provider Details

I. General information

NPI: 1083985758
Provider Name (Legal Business Name): AUBURN ENLARGED SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 LAKE AVE
AUBURN NY
13021-5330
US

IV. Provider business mailing address

250 LAKE AVE
AUBURN NY
13021-5330
US

V. Phone/Fax

Practice location:
  • Phone: 315-255-8319
  • Fax: 315-255-8357
Mailing address:
  • Phone: 315-255-8319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number245130-1
License Number StateNY

VIII. Authorized Official

Name: MRS. LAURA OWEN
Title or Position: DIRECTOR OF SPECIAL EDUCATIO
Credential:
Phone: 315-255-8811