Provider Demographics
NPI:1144401993
Name:JL SCHOOL DIST 1
Entity Type:Organization
Organization Name:JL SCHOOL DIST 1
Other - Org Name:BEECHER DUNBAR PEMBINE SCHOOL DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-324-5314
Mailing Address - Street 1:N18775 SAULD ST
Mailing Address - Street 2:PO BOX 247
Mailing Address - City:PEMBINE
Mailing Address - State:WI
Mailing Address - Zip Code:54156
Mailing Address - Country:US
Mailing Address - Phone:715-324-5314
Mailing Address - Fax:715-324-5282
Practice Address - Street 1:N18775 SAULD ST
Practice Address - Street 2:
Practice Address - City:PEMBINE
Practice Address - State:WI
Practice Address - Zip Code:54156
Practice Address - Country:US
Practice Address - Phone:715-324-5314
Practice Address - Fax:715-324-5282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44240000Medicaid