Provider Demographics
NPI:1174827208
Name:CLAY CENTRAL-EVERLY C.S.D.
Entity Type:Organization
Organization Name:CLAY CENTRAL-EVERLY C.S.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-933-2242
Mailing Address - Street 1:401 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL
Mailing Address - State:IA
Mailing Address - Zip Code:51357-7719
Mailing Address - Country:US
Mailing Address - Phone:712-933-2242
Mailing Address - Fax:712-933-2243
Practice Address - Street 1:401 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ROYAL
Practice Address - State:IA
Practice Address - Zip Code:51357-7719
Practice Address - Country:US
Practice Address - Phone:712-933-2242
Practice Address - Fax:712-933-2243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0403080Medicaid