Provider Demographics
NPI:1104005883
Name:SCHOOL DISTRICT OF ELMWOOD
Entity Type:Organization
Organization Name:SCHOOL DISTRICT OF ELMWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-639-2711
Mailing Address - Street 1:213 S SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:54740-8645
Mailing Address - Country:US
Mailing Address - Phone:715-639-2711
Mailing Address - Fax:
Practice Address - Street 1:213 S SCOTT ST
Practice Address - Street 2:
Practice Address - City:ELMWOOD
Practice Address - State:WI
Practice Address - Zip Code:54740-8645
Practice Address - Country:US
Practice Address - Phone:715-639-2711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44237600Medicaid