Provider Demographics
NPI:1386823763
Name:MENOMINEE INDIAN SCHOOL DISTRICT
Entity Type:Organization
Organization Name:MENOMINEE INDIAN SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HINKFUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-799-3824
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:KESHENA
Mailing Address - State:WI
Mailing Address - Zip Code:54135-1330
Mailing Address - Country:US
Mailing Address - Phone:715-799-3824
Mailing Address - Fax:715-799-1353
Practice Address - Street 1:N522 STATE HIGHWAY 47/55
Practice Address - Street 2:
Practice Address - City:KESHENA
Practice Address - State:WI
Practice Address - Zip Code:54135-1330
Practice Address - Country:US
Practice Address - Phone:715-799-3824
Practice Address - Fax:715-799-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44213900Medicaid