Provider Demographics
NPI:1962558411
Name:SOUTH COUNTRY CENTRAL SCHOOL DISTRICT
Entity type:Organization
Organization Name:SOUTH COUNTRY CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, STUDENT SUPPORT SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORREALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-730-1781
Mailing Address - Street 1:189 N DUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-5587
Mailing Address - Country:US
Mailing Address - Phone:631-730-1781
Mailing Address - Fax:631-286-4914
Practice Address - Street 1:189 N DUNTON AVE
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-5587
Practice Address - Country:US
Practice Address - Phone:631-730-1781
Practice Address - Fax:631-286-4914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
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
NY01217716Medicaid