Provider Demographics
NPI:1346306834
Name:ISD # 13 COLUMBIA HEIGHTS
Entity Type:Organization
Organization Name:ISD # 13 COLUMBIA HEIGHTS
Other - Org Name:COLUMBIA HEIGHTS ISD # 13
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF BUSINESS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:PRIMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-528-4411
Mailing Address - Street 1:1440 49TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421
Mailing Address - Country:US
Mailing Address - Phone:763-528-4411
Mailing Address - Fax:763-528-4411
Practice Address - Street 1:1440 49TH AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421
Practice Address - Country:US
Practice Address - Phone:763-528-4411
Practice Address - Fax:763-528-4411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISD # 13 COLUMBIA HEIGHTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-29
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN126668300OtherMA