Basic Information
| Provider Information | |||||||||
| NPI: | 1962569301 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOMER CENTRAL SCHOOL DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 500 | ||||||||
| Address2: | |||||||||
| City: | HOMER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130770500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077497246 | ||||||||
| FaxNumber: | 6077492312 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 S WEST ST | ||||||||
| Address2: | |||||||||
| City: | HOMER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130771513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077491226 | ||||||||
| FaxNumber: | 6077492312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 04/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | FALLS | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF BUSINESS | ||||||||
| AuthorizedOfficialTelephone: | 6077497241 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | Y | Agencies | Local Education Agency (LEA) |
ID Information
| ID | Type | State | Issuer | Description | 01382250 | 05 | NY | MEDICAID |