Healthcare Provider Details

I. General information

NPI: 1821142548
Provider Name (Legal Business Name): ST. JOHNSVILLE CENTRAL SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

61 MONROE ST
ST JOHNSVILLE NY
13452-1125
US

IV. Provider business mailing address

61 MONROE ST
ST JOHNSVILLE NY
13452-1125
US

V. Phone/Fax

Practice location:
  • Phone: 518-568-7023
  • Fax: 518-568-5407
Mailing address:
  • Phone: 518-568-7023
  • Fax: 518-568-5407

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: MRS. LAURA CAMPIONE
Title or Position: PRINCIPALCSE CHAIRPERSON
Credential:
Phone: 518-568-7023