=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154772119
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BELVIDERE SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2016
-----------------------------------------------------
Last Update Date | 06/30/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 809 OXFORD ST
-----------------------------------------------------
City | BELVIDERE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07823-1701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-475-4025
-----------------------------------------------------
Fax | 908-475-6619
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 809 OXFORD ST
-----------------------------------------------------
City | BELVIDERE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07823-1701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-475-4025
-----------------------------------------------------
Fax | 908-475-6619
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CST SUPERVISOR
-----------------------------------------------------
Name | DANIELLE RAMBO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 908-475-4025
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------