Provider Demographics
NPI:1275131005
Name:BISMARCK PUBLIC SCHOOLS EARLY INTERVENTION
Entity Type:Organization
Organization Name:BISMARCK PUBLIC SCHOOLS EARLY INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EARLY INTERVENTION COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUTOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:701-323-4448
Mailing Address - Street 1:806 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3623
Mailing Address - Country:US
Mailing Address - Phone:701-323-4448
Mailing Address - Fax:
Practice Address - Street 1:806 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3623
Practice Address - Country:US
Practice Address - Phone:701-323-4448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCHOOL BOARD OF BISMARCK PUBLIC SCHOOL DISTRICT NO 1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND39DD-372Medicaid