Provider Demographics
NPI:1376576587
Name:LIBERTY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:LIBERTY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:HODGSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-245-3211
Mailing Address - Street 1:29818 S NORTH PINE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SPANGLE
Mailing Address - State:WA
Mailing Address - Zip Code:99031-9707
Mailing Address - Country:US
Mailing Address - Phone:509-245-3223
Mailing Address - Fax:509-245-3288
Practice Address - Street 1:29818 S NORTH PINE CREEK RD
Practice Address - Street 2:
Practice Address - City:SPANGLE
Practice Address - State:WA
Practice Address - Zip Code:99031-9707
Practice Address - Country:US
Practice Address - Phone:509-245-3223
Practice Address - Fax:509-245-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7441215Medicaid