Provider Demographics
NPI:1528104478
Name:TOWN OF OLIVE
Entity type:Organization
Organization Name:TOWN OF OLIVE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SCHOOL SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-657-8851
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:BOICEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12412-0300
Mailing Address - Country:US
Mailing Address - Phone:845-657-8743
Mailing Address - Fax:845-657-8742
Practice Address - Street 1:4166 ROUTE 28
Practice Address - Street 2:
Practice Address - City:BOICEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12412-0300
Practice Address - Country:US
Practice Address - Phone:845-657-8743
Practice Address - Fax:845-657-8742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01422068Medicaid