Provider Demographics
NPI:1215081260
Name:GORHAM MIDDLESEX CENTRAL SCHOOL
Entity type:Organization
Organization Name:GORHAM MIDDLESEX CENTRAL SCHOOL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR STUDENT SUPPORT SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-554-6441
Mailing Address - Street 1:4100 BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14544-9738
Mailing Address - Country:US
Mailing Address - Phone:585-554-6441
Mailing Address - Fax:585-554-6176
Practice Address - Street 1:4100 BALDWIN RD
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14544-9738
Practice Address - Country:US
Practice Address - Phone:585-554-6441
Practice Address - Fax:585-554-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01382205Medicaid