Provider Demographics
NPI:1528112539
Name:PEMBROKE CENTRAL SCHOOLS
Entity type:Organization
Organization Name:PEMBROKE CENTRAL SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR OF INSTRUCTIONAL SUPPOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MSE
Authorized Official - Phone:585-599-4525
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:8750 ALLEGHENY RD.
Mailing Address - City:CORFU
Mailing Address - State:NY
Mailing Address - Zip Code:14036
Mailing Address - Country:US
Mailing Address - Phone:585-599-4525
Mailing Address - Fax:585-599-4213
Practice Address - Street 1:58 ALLEGHENY RD.
Practice Address - Street 2:
Practice Address - City:CORFU
Practice Address - State:NY
Practice Address - Zip Code:14036
Practice Address - Country:US
Practice Address - Phone:585-599-4525
Practice Address - Fax:585-599-4213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01392992Medicaid