Provider Demographics
NPI:1275858854
Name:HOOD RIVER COUNTY SCHOOL DISTRICT EI/ECSE PROGRAM
Entity Type:Organization
Organization Name:HOOD RIVER COUNTY SCHOOL DISTRICT EI/ECSE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER/DEPUTY CLERK
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-387-5010
Mailing Address - Street 1:1011 EUGENE ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1415
Mailing Address - Country:US
Mailing Address - Phone:541-387-5010
Mailing Address - Fax:541-387-5099
Practice Address - Street 1:455 FRANKTON RD
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-9737
Practice Address - Country:US
Practice Address - Phone:541-387-5077
Practice Address - Fax:541-387-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251300000X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR235305Medicaid