Provider Demographics
NPI:1245411305
Name:SOUTH WINNESHIEK COMM SCHOOL
Entity Type:Organization
Organization Name:SOUTH WINNESHIEK COMM SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DONLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-562-3269
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:CALMAR
Mailing Address - State:IA
Mailing Address - Zip Code:52132-0430
Mailing Address - Country:US
Mailing Address - Phone:563-562-3269
Mailing Address - Fax:563-562-3260
Practice Address - Street 1:304 S WEBSTER ST
Practice Address - Street 2:
Practice Address - City:CALMAR
Practice Address - State:IA
Practice Address - Zip Code:52132-0430
Practice Address - Country:US
Practice Address - Phone:563-562-3269
Practice Address - Fax:563-562-3260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0764696Medicaid