Provider Demographics
NPI:1083643746
Name:CHIMACUM SCHOOL DISTRICT #49
Entity Type:Organization
Organization Name:CHIMACUM SCHOOL DISTRICT #49
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL SERVICES DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-732-4285
Mailing Address - Street 1:91 WEST VALLEY RD
Mailing Address - Street 2:PO BOX 10
Mailing Address - City:CHIMACUM
Mailing Address - State:WA
Mailing Address - Zip Code:98325
Mailing Address - Country:US
Mailing Address - Phone:360-732-4285
Mailing Address - Fax:360-732-7001
Practice Address - Street 1:91 WEST VALLEY RD
Practice Address - Street 2:
Practice Address - City:CHIMACUM
Practice Address - State:WA
Practice Address - Zip Code:98325
Practice Address - Country:US
Practice Address - Phone:360-732-4285
Practice Address - Fax:360-732-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7442114Medicaid