Provider Demographics
NPI:1205851623
Name:JACKSON COUNTY INTERMEDIATE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:JACKSON COUNTY INTERMEDIATE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:517-768-5200
Mailing Address - Street 1:6700 BROWNS LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8379
Mailing Address - Country:US
Mailing Address - Phone:517-768-5200
Mailing Address - Fax:517-768-5261
Practice Address - Street 1:6700 BROWNS LAKE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-8379
Practice Address - Country:US
Practice Address - Phone:517-768-5200
Practice Address - Fax:517-768-5261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
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
MI2749448Medicaid