Provider Demographics
NPI:1235406075
Name:CALLAWAY COUNTY R-111 SCHOOL
Entity Type:Organization
Organization Name:CALLAWAY COUNTY R-111 SCHOOL
Other - Org Name:NEW BLOOMFIELD R-III SCHOOL DIST
Other - Org Type:Other Name
Authorized Official - Title/Position:SPECIAL SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WISDOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-491-3700
Mailing Address - Street 1:307 REDWOOD DR
Mailing Address - Street 2:PO BOX 188
Mailing Address - City:NEW BLOOMFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65063-5417
Mailing Address - Country:US
Mailing Address - Phone:573-491-3700
Mailing Address - Fax:573-491-3772
Practice Address - Street 1:307 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:NEW BLOOMFIELD
Practice Address - State:MO
Practice Address - Zip Code:65063-5417
Practice Address - Country:US
Practice Address - Phone:573-491-3700
Practice Address - Fax:573-491-3772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)