Provider Demographics
NPI:1225105406
Name:INDEPENDENT SCHOOL DISTRICT 879
Entity Type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT 879
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEET
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR
Authorized Official - Phone:763-972-3365
Mailing Address - Street 1:700 ELM AVE E
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-8236
Mailing Address - Country:US
Mailing Address - Phone:763-972-3365
Mailing Address - Fax:763-972-6706
Practice Address - Street 1:700 ELM AVE E
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-8236
Practice Address - Country:US
Practice Address - Phone:763-972-3365
Practice Address - Fax:763-972-6706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN36247200OtherMEDICAL ASSISTANCE