Provider Demographics
NPI:1104971720
Name:WAYNE COUNTY BOARD OF EDUCATION
Entity type:Organization
Organization Name:WAYNE COUNTY BOARD OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-348-8484
Mailing Address - Street 1:1025 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-2762
Mailing Address - Country:US
Mailing Address - Phone:606-348-8484
Mailing Address - Fax:606-348-0734
Practice Address - Street 1:1025 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-2762
Practice Address - Country:US
Practice Address - Phone:606-348-8484
Practice Address - Fax:606-348-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251300000X
251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY21116033Medicaid