Provider Demographics
NPI:1073738753
Name:KOOTENAI COUNTY
Entity Type:Organization
Organization Name:KOOTENAI COUNTY
Other - Org Name:POST FALLS SCHOOL DISTRICT 273
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-773-1658
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:206 W MULLAN AVE
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-0040
Mailing Address - Country:US
Mailing Address - Phone:208-773-1658
Mailing Address - Fax:208-773-3218
Practice Address - Street 1:206 W MULLAN AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7255
Practice Address - Country:US
Practice Address - Phone:208-773-1658
Practice Address - Fax:208-773-3218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0028178251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0028178Medicaid