Provider Demographics
NPI:1396878088
Name:CHEEKTOWAGA CENTRAL SCHOOL DISTRICT
Entity type:Organization
Organization Name:CHEEKTOWAGA CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JUREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-686-3643
Mailing Address - Street 1:3600 UNION RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-5124
Mailing Address - Country:US
Mailing Address - Phone:716-686-3643
Mailing Address - Fax:716-681-5232
Practice Address - Street 1:3600 UNION RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-5124
Practice Address - Country:US
Practice Address - Phone:716-686-3643
Practice Address - Fax:716-681-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
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
NY01379304Medicaid