Provider Demographics
NPI:1134309024
Name:ELKTON SCHOOL DISTRICT 5-3
Entity Type:Organization
Organization Name:ELKTON SCHOOL DISTRICT 5-3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MOE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-542-2541
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57026-0190
Mailing Address - Country:US
Mailing Address - Phone:605-542-2541
Mailing Address - Fax:605-542-4441
Practice Address - Street 1:508 BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:SD
Practice Address - Zip Code:57026-0190
Practice Address - Country:US
Practice Address - Phone:605-542-2541
Practice Address - Fax:605-542-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD515-0360Medicaid