Provider Demographics
NPI:1154486959
Name:INDEPENDENT SCHOOL DISTRICT NO 2859
Entity Type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT NO 2859
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RAITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-864-2486
Mailing Address - Street 1:1621 16TH ST E
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:MN
Mailing Address - Zip Code:55336-1721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1621 16TH ST E
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:MN
Practice Address - Zip Code:55336-1721
Practice Address - Country:US
Practice Address - Phone:320-864-2491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN881490200251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN881490200Medicaid