Provider Demographics
NPI:1316024219
Name:SERGEANT BLUFF-LUTON COMMUNITY SCHOOL
Entity Type:Organization
Organization Name:SERGEANT BLUFF-LUTON COMMUNITY SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-943-4338
Mailing Address - Street 1:201 PORT NEAL RD
Mailing Address - Street 2:P O BOX 97
Mailing Address - City:SERGEANT BLUFF
Mailing Address - State:IA
Mailing Address - Zip Code:51054-0097
Mailing Address - Country:US
Mailing Address - Phone:712-943-4338
Mailing Address - Fax:712-943-1131
Practice Address - Street 1:201 PORT NEAL RD
Practice Address - Street 2:
Practice Address - City:SERGEANT BLUFF
Practice Address - State:IA
Practice Address - Zip Code:51054-0097
Practice Address - Country:US
Practice Address - Phone:712-943-4338
Practice Address - Fax:712-943-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0416149Medicaid