Healthcare Provider Details

I. General information

NPI: 1750431086
Provider Name (Legal Business Name): WATERVILLE CENTRAL SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 MADISON ST
WATERVILLE NY
13480-1115
US

IV. Provider business mailing address

381 MADISON ST
WATERVILLE NY
13480-1115
US

V. Phone/Fax

Practice location:
  • Phone: 315-841-3900
  • Fax: 315-841-3939
Mailing address:
  • Phone: 315-841-3900
  • Fax: 315-841-3939

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. JAMES VANWORMER
Title or Position: SUPERINTENDENT OF SCHOOLS
Credential:
Phone: 315-841-3910