Provider Demographics
NPI:1174677603
Name:VALLIVUE SCHOOL DISTRICT #139
Entity Type:Organization
Organization Name:VALLIVUE SCHOOL DISTRICT #139
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-454-0445
Mailing Address - Street 1:5207 S MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-1583
Mailing Address - Country:US
Mailing Address - Phone:208-454-0445
Mailing Address - Fax:208-454-0778
Practice Address - Street 1:5207 S MONTANA AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-1583
Practice Address - Country:US
Practice Address - Phone:208-454-0445
Practice Address - Fax:208-454-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805272800Medicaid