Provider Demographics
NPI:1144238940
Name:TRAVERSE BAY AREA INTERMEDIATE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:TRAVERSE BAY AREA INTERMEDIATE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-922-6200
Mailing Address - Street 1:1101 RED DR
Mailing Address - Street 2:P.O. BOX 6020
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4465
Mailing Address - Country:US
Mailing Address - Phone:231-922-6200
Mailing Address - Fax:231-922-6407
Practice Address - Street 1:1101 RED DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4465
Practice Address - Country:US
Practice Address - Phone:231-922-6200
Practice Address - Fax:231-922-6407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2958994Medicaid