Provider Demographics
NPI:1346331469
Name:INTERMEDIATE SCHOOL DISTRICT 917
Entity Type:Organization
Organization Name:INTERMEDIATE SCHOOL DISTRICT 917
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHRISTIANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-423-8226
Mailing Address - Street 1:1300 145TH ST E
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-2932
Mailing Address - Country:US
Mailing Address - Phone:651-423-8000
Mailing Address - Fax:651-423-8776
Practice Address - Street 1:1300 145TH ST E
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-2932
Practice Address - Country:US
Practice Address - Phone:651-423-8000
Practice Address - Fax:651-423-8776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN998152700Medicaid