1770351512 NPI number — SOUTHEAST VALLEY COMMUNITY SCHOOL DISTRICT

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 1770351512 NPI number — SOUTHEAST VALLEY COMMUNITY SCHOOL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHEAST VALLEY COMMUNITY SCHOOL DISTRICT
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:
1770351512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 49
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOWRIE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50543-0049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-352-5571
Provider Business Mailing Address Fax Number:
515-352-5573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 BEEK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOWRIE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50543-7547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-352-5571
Provider Business Practice Location Address Fax Number:
515-352-5573
Provider Enumeration Date:
12/12/2023

Additional Information

Authorized Official

Authorized Official Last Name:
WILLARDSON
Authorized Official First Name:
LISA
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
515-352-5571

Provider Taxonomy Codes

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

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





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