Provider Demographics
NPI:1164451878
Name:LA GRANDE SD
Entity Type:Organization
Organization Name:LA GRANDE SD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-663-3202
Mailing Address - Street 1:708 K AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-1392
Mailing Address - Country:US
Mailing Address - Phone:541-663-3202
Mailing Address - Fax:541-663-3211
Practice Address - Street 1:708 K AVE STE 100
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1392
Practice Address - Country:US
Practice Address - Phone:541-663-3202
Practice Address - Fax:541-663-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
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
OR000672Medicaid