Provider Demographics
NPI:1528117272
Name:ALEXANDRIA CSD
Entity type:Organization
Organization Name:ALEXANDRIA CSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRIANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KIRCHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-482-9971
Mailing Address - Street 1:34 BOLTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA BAY
Mailing Address - State:NY
Mailing Address - Zip Code:13607-1603
Mailing Address - Country:US
Mailing Address - Phone:315-482-9971
Mailing Address - Fax:315-482-9973
Practice Address - Street 1:34 BOLTON AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA BAY
Practice Address - State:NY
Practice Address - Zip Code:13607-1603
Practice Address - Country:US
Practice Address - Phone:315-482-9971
Practice Address - Fax:315-482-9973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01423798Medicaid