Healthcare Provider Details

I. General information

NPI: 1568511251
Provider Name (Legal Business Name): SULLIVAN WEST CENTRAL SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 SCHOOL HOUSE HILL ROAD
JEFFERSONVILLE NY
12764
US

IV. Provider business mailing address

PO BOX 308 33 SCHOOLHOUSE ROAD
JEFFERSONVILLE NY
12748-0308
US

V. Phone/Fax

Practice location:
  • Phone: 845-482-4610
  • Fax: 845-482-4620
Mailing address:
  • Phone: 845-482-4610
  • Fax: 845-482-4620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MR. ALAN DERRY
Title or Position: SUPERINTENDENT
Credential:
Phone: 845-482-4610