Provider Demographics
NPI:1417014267
Name:TOWNS OF BRASHER LAWRENCE CENTRAL SCHOOL DIST 1
Entity type:Organization
Organization Name:TOWNS OF BRASHER LAWRENCE CENTRAL SCHOOL DIST 1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-389-5131
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:BRASHER FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13613-0307
Mailing Address - Country:US
Mailing Address - Phone:315-389-5131
Mailing Address - Fax:315-389-5245
Practice Address - Street 1:1039 STATE HIGHWAY 11C
Practice Address - Street 2:
Practice Address - City:BRASHER FALLS
Practice Address - State:NY
Practice Address - Zip Code:13613-4104
Practice Address - Country:US
Practice Address - Phone:315-389-5131
Practice Address - Fax:315-389-5245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01419341Medicaid