Provider Demographics
NPI:1346579851
Name:SKYKOMISH SCHOOL DISTRICT
Entity Type:Organization
Organization Name:SKYKOMISH SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-677-2623
Mailing Address - Street 1:105 SIXTH STREET NORTH
Mailing Address - Street 2:PO BOX 325
Mailing Address - City:SKYKOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98288-0325
Mailing Address - Country:US
Mailing Address - Phone:360-677-2623
Mailing Address - Fax:360-677-2418
Practice Address - Street 1:105 SIXTH STREET NORTH
Practice Address - Street 2:
Practice Address - City:SKYKOMISH
Practice Address - State:WA
Practice Address - Zip Code:98288-0325
Practice Address - Country:US
Practice Address - Phone:360-677-2623
Practice Address - Fax:360-677-2418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7442700Medicaid