1134232853 NPI number — CHARLEVOIX-EMMET INTERMEDIATE 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 1134232853 NPI number — CHARLEVOIX-EMMET INTERMEDIATE SCHOOL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLEVOIX-EMMET INTERMEDIATE 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:
1134232853
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
08568 MERCER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLEVOIX
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-547-9947
Provider Business Mailing Address Fax Number:
231-547-5621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8568 MERCER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLEVOIX
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49720-1006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-547-9947
Provider Business Practice Location Address Fax Number:
231-547-5621
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ECKHARDT
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERINTENDENT
Authorized Official Telephone Number:
231-547-9947

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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