Provider Demographics
NPI:1306037536
Name:LAKE CHELAN SCHOOL DISTRICT
Entity Type:Organization
Organization Name:LAKE CHELAN SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-682-3515
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-0369
Mailing Address - Country:US
Mailing Address - Phone:509-682-3515
Mailing Address - Fax:
Practice Address - Street 1:303 E. JOHNSON AVENUE
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-0369
Practice Address - Country:US
Practice Address - Phone:509-682-3515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7440597Medicaid