Provider Demographics
NPI:1114678182
Name:BROKEN BOW PUBLIC SCHOOLS COUNTY OF CUSTER SCHOOL DISTRICT 25
Entity Type:Organization
Organization Name:BROKEN BOW PUBLIC SCHOOLS COUNTY OF CUSTER SCHOOL DISTRICT 25
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPED ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAYOR-GASTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-872-6821
Mailing Address - Street 1:323 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-1718
Mailing Address - Country:US
Mailing Address - Phone:308-872-6821
Mailing Address - Fax:308-872-2751
Practice Address - Street 1:323 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-1718
Practice Address - Country:US
Practice Address - Phone:308-872-6821
Practice Address - Fax:308-872-2751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center