Provider Demographics
NPI:1114097318
Name:MT. ADAMS SCHOOL DISTRICT 209
Entity Type:Organization
Organization Name:MT. ADAMS SCHOOL DISTRICT 209
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:STARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-848-5755
Mailing Address - Street 1:621 SIGNAL PEAK RD
Mailing Address - Street 2:PO BOX 578
Mailing Address - City:WHITE SWAN
Mailing Address - State:WA
Mailing Address - Zip Code:98952
Mailing Address - Country:US
Mailing Address - Phone:509-848-5710
Mailing Address - Fax:509-848-5750
Practice Address - Street 1:621 SIGNAL PEAK RD
Practice Address - Street 2:
Practice Address - City:WHITE SWAN
Practice Address - State:WA
Practice Address - Zip Code:98952
Practice Address - Country:US
Practice Address - Phone:509-848-5710
Practice Address - Fax:509-848-5750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7440225Medicaid