Provider Demographics
NPI:1134301955
Name:ELLSWORTH COMMUNITY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:ELLSWORTH COMMUNITY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-273-3900
Mailing Address - Street 1:300 HILLCREST ST
Mailing Address - Street 2:BOX 1500
Mailing Address - City:ELLSWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:54011
Mailing Address - Country:US
Mailing Address - Phone:715-273-3900
Mailing Address - Fax:
Practice Address - Street 1:300 HILLCREST ST
Practice Address - Street 2:BOX 1500
Practice Address - City:ELLSWORTH
Practice Address - State:WI
Practice Address - Zip Code:54011
Practice Address - Country:US
Practice Address - Phone:715-273-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
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
WI44237700Medicaid