Provider Demographics
NPI:1063564656
Name:JAMESVILLE DEWITT CSD
Entity type:Organization
Organization Name:JAMESVILLE DEWITT CSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:315-445-8304
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-0606
Mailing Address - Country:US
Mailing Address - Phone:315-445-8300
Mailing Address - Fax:
Practice Address - Street 1:6845 EDINGER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1768
Practice Address - Country:US
Practice Address - Phone:315-445-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01646079Medicaid