1427277060 NPI number — ROOSEVELT CITY DISTRICT BAINVILLE SCHOOL 64D

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 1427277060 NPI number — ROOSEVELT CITY DISTRICT BAINVILLE SCHOOL 64D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROOSEVELT CITY DISTRICT BAINVILLE SCHOOL 64D
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:
ROOSE VALLEY SPECIAL EDUC COOP
Provider Other Organization Name Type Code:
3
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:
1427277060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
12/03/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 TUBMAN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAINVILLE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59212-0177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-769-2321
Provider Business Mailing Address Fax Number:
406-769-2321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 TUBMAN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAINVILLE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59212-0177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-769-2321
Provider Business Practice Location Address Fax Number:
406-769-2321
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LUDWICK
Authorized Official First Name:
THALE
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
406-769-2321

Provider Taxonomy Codes

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

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

  • Identifier: 0162825 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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