Provider Demographics
NPI:1710034624
Name:HORSEHEADS CSD
Entity type:Organization
Organization Name:HORSEHEADS CSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STUDENT SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-795-2400
Mailing Address - Street 1:1 RAIDER LN
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-2344
Mailing Address - Country:US
Mailing Address - Phone:607-795-2400
Mailing Address - Fax:607-795-2445
Practice Address - Street 1:1 RAIDER LN
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2344
Practice Address - Country:US
Practice Address - Phone:607-795-2400
Practice Address - Fax:607-795-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070901OtherNYS DEPARTMANT OF EDUCATION
NY01382241Medicaid