Provider Demographics
NPI:1336298116
Name:WAVERLY SHELL ROCK COMMUNITY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:WAVERLY SHELL ROCK COMMUNITY SCHOOL DISTRICT
Other - Org Name:AREA EDUCATION AGENCY 267
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERE
Authorized Official - Middle Name:
Authorized Official - Last Name:VYVERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-352-3630
Mailing Address - Street 1:1415 4TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2821
Mailing Address - Country:US
Mailing Address - Phone:319-352-3630
Mailing Address - Fax:319-352-5676
Practice Address - Street 1:1415 4TH AVE SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2821
Practice Address - Country:US
Practice Address - Phone:319-352-3630
Practice Address - Fax:319-352-5676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
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
IA0441089Medicaid