1396968988 NPI number — IND. SCHOOL DISTRICT 314

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396968988 NPI number — IND. SCHOOL DISTRICT 314

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IND. SCHOOL DISTRICT 314
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396968988
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 BUCHANAN ST N
Provider Second Line Business Mailing Address:
STE. 150
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55008-1638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-689-3600
Provider Business Mailing Address Fax Number:
763-689-3601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
531 ELMHURST AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRAHAM
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55006-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-396-3313
Provider Business Practice Location Address Fax Number:
320-396-0086
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RUPRECHT
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF SPECIAL EDUCATION
Authorized Official Telephone Number:
763-689-3600

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , with the licence number:  8005295 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 046605100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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