=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699830307
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BELLEVILLE HENDERSON CENTRAL SCHOOL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8372 RT 75
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13611-0158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-846-5825
-----------------------------------------------------
Fax | 315-846-5617
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8372 RT 75 BOX 158
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13611-0158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-846-5825
-----------------------------------------------------
Fax | 315-846-5617
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CSE CHAIRPERSON
-----------------------------------------------------
Name | MRS. SUSAN THOMAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 315-846-5825
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------