Provider Demographics
NPI:1376557066
Name:LAURENS SCHOOL DIST#55
Entity Type:Organization
Organization Name:LAURENS SCHOOL DIST#55
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL SERVICESMEDICAID
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNADY
Authorized Official - Suffix:
Authorized Official - Credentials:SCHOOL DISTRICT
Authorized Official - Phone:864-984-8128
Mailing Address - Street 1:1029 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-2654
Mailing Address - Country:US
Mailing Address - Phone:864-984-8128
Mailing Address - Fax:864-984-8113
Practice Address - Street 1:1029 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-2654
Practice Address - Country:US
Practice Address - Phone:864-984-8128
Practice Address - Fax:864-984-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSD3055Medicaid