Provider Demographics
NPI:1386860666
Name:SCHOOL DISTRICT OF ELMBROOK
Entity Type:Organization
Organization Name:SCHOOL DISTRICT OF ELMBROOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STUDENT LEARNING SP ND
Authorized Official - Prefix:MS
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAVROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-781-3030
Mailing Address - Street 1:13780 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-1730
Mailing Address - Country:US
Mailing Address - Phone:262-781-3030
Mailing Address - Fax:262-790-4092
Practice Address - Street 1:13780 HOPE ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-1730
Practice Address - Country:US
Practice Address - Phone:262-781-3030
Practice Address - Fax:262-790-4092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44210600Medicaid