Provider Demographics
NPI:1164668398
Name:INDIAN LAKE LOCAL SCHOOLS
Entity Type:Organization
Organization Name:INDIAN LAKE LOCAL SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGLOTHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-686-8601
Mailing Address - Street 1:6210 STATE ROUTE 235 N
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43333-9704
Mailing Address - Country:US
Mailing Address - Phone:937-686-8004
Mailing Address - Fax:937-686-8421
Practice Address - Street 1:6210 STATE ROUTE 235 N
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:OH
Practice Address - Zip Code:43333-9704
Practice Address - Country:US
Practice Address - Phone:937-686-8004
Practice Address - Fax:937-686-8421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)