1821153347 NPI number — ST. LOUIS & KOOCHICHING COS IND SCHOOL DIST 707

Table of content: (NPI 1821153347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821153347 NPI number — ST. LOUIS & KOOCHICHING COS IND SCHOOL DIST 707

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. LOUIS & KOOCHICHING COS IND SCHOOL DIST 707
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:
6
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:
1821153347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 S 13TH AVE
Provider Second Line Business Mailing Address:
PO BOX 1286
Provider Business Mailing Address City Name:
VIRGINIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55792-3361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-741-5284
Provider Business Mailing Address Fax Number:
218-741-5384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13090 WESTLEY DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NETT LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55772-8122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-757-3102
Provider Business Practice Location Address Fax Number:
218-757-3330
Provider Enumeration Date:
12/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ENGEBRITSON
Authorized Official First Name:
REGGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF SPECIAL EDUCATION
Authorized Official Telephone Number:
218-741-5284

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , 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: 676855500 . This is a "MN-ITS USER ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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