Healthcare Provider Details

I. General information

NPI: 1376697375
Provider Name (Legal Business Name): LEWISTON PORTER CENTRAL SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 CREEK RD.
YOUNGSTOWN NY
14174
US

IV. Provider business mailing address

4601 CREEK RD.
YOUNGSTOWN NY
14174
US

V. Phone/Fax

Practice location:
  • Phone: 716-754-8281
  • Fax:
Mailing address:
  • Phone: 716-754-8281
  • Fax:

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: BARBARA GODSHALL
Title or Position: DIRECTOR OF SPECIAL EDUCATION
Credential: ED.D.
Phone: 716-754-8281