=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528104478
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOWN OF OLIVE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2007
-----------------------------------------------------
Last Update Date | 08/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4166 ROUTE 28
-----------------------------------------------------
City | BOICEVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12412-0300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-657-8743
-----------------------------------------------------
Fax | 845-657-8742
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 300
-----------------------------------------------------
City | BOICEVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12412-0300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-657-8743
-----------------------------------------------------
Fax | 845-657-8742
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SCHOOL SUPERINTENDENT
-----------------------------------------------------
Name | DR. LESLIE FORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-657-8851
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------