Provider Demographics
NPI:1285789966
Name:LAKE PLEASANT CENTRAL SCHOOL
Entity type:Organization
Organization Name:LAKE PLEASANT CENTRAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-548-7571
Mailing Address - Street 1:PO BOX 140
Mailing Address - Street 2:ELM LAKE ROAD
Mailing Address - City:SPECULATOR
Mailing Address - State:NY
Mailing Address - Zip Code:12164-0140
Mailing Address - Country:US
Mailing Address - Phone:518-548-7571
Mailing Address - Fax:518-548-3230
Practice Address - Street 1:ELM LAKE ROAD
Practice Address - Street 2:
Practice Address - City:SPECULATOR
Practice Address - State:NY
Practice Address - Zip Code:12164-0140
Practice Address - Country:US
Practice Address - Phone:518-548-7571
Practice Address - Fax:518-548-3230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01398609Medicaid