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General NPI Number Information
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NPI Number | 1730217092
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Entity Type | Organization
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Legal Business Name | VAN HORNESVILLE-OWEN D YOUNG CSD
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 2316 STATE ROUTE 80
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City | VAN HORNESVILLE
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State | NY
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Zip | 13475-0125
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Country | US
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Telephone | 315-858-0336
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Fax | 315-858-1468
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Provider Business Mailing Address
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Address Line | P.O. BOX 125
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City | VAN HORNESVILLE
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State | NY
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Zip | 13475
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Country | US
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Telephone | 315-858-0336
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Fax | 315-858-1468
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR
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Name | JODIE L. RODRIQUEZ
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Credential |
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Telephone | 315-858-0336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | 01396914
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License Number State | NY
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