Healthcare Provider Details

I. General information

NPI: 1780735829
Provider Name (Legal Business Name): CHAUTAUQUA LAKE CENTRAL SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ERIE ST
MAYVILLE NY
14757-9755
US

IV. Provider business mailing address

100 N ERIE ST
MAYVILLE NY
14757-9755
US

V. Phone/Fax

Practice location:
  • Phone: 716-753-5877
  • Fax: 716-753-5876
Mailing address:
  • Phone: 716-753-5877
  • Fax: 716-753-5876

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: KATHY FREEMAN
Title or Position: TYPIST II
Credential:
Phone: 716-753-5877