Provider Demographics
NPI:1023035870
Name:COUNCIL BLUFFS COMMUNITY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:COUNCIL BLUFFS COMMUNITY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR OF STUDENT SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIIMIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-328-6430
Mailing Address - Street 1:12 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0782
Mailing Address - Country:US
Mailing Address - Phone:712-328-6400
Mailing Address - Fax:712-328-6488
Practice Address - Street 1:12 SCOTT ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0782
Practice Address - Country:US
Practice Address - Phone:712-328-6400
Practice Address - Fax:712-328-6488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0248666Medicaid