Provider Demographics
NPI:1093933137
Name:BLACK HAWK SCHOOL DISTRICT
Entity Type:Organization
Organization Name:BLACK HAWK SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-439-5400
Mailing Address - Street 1:202 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WAYNE
Mailing Address - State:WI
Mailing Address - Zip Code:53587-9509
Mailing Address - Country:US
Mailing Address - Phone:608-439-5400
Mailing Address - Fax:608-439-1022
Practice Address - Street 1:202 W CENTER ST
Practice Address - Street 2:
Practice Address - City:SOUTH WAYNE
Practice Address - State:WI
Practice Address - Zip Code:53587-9509
Practice Address - Country:US
Practice Address - Phone:608-439-5400
Practice Address - Fax:608-439-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44239600Medicaid