Provider Demographics
NPI:1407331663
Name:LAKE COUNTY SCHOOL DISTRICT 11C
Entity Type:Organization
Organization Name:LAKE COUNTY SCHOOL DISTRICT 11C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-943-3111
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:PAISLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97636-0097
Mailing Address - Country:US
Mailing Address - Phone:541-943-3111
Mailing Address - Fax:541-943-3129
Practice Address - Street 1:260 GREEN STREET
Practice Address - Street 2:
Practice Address - City:PAISLEY
Practice Address - State:OR
Practice Address - Zip Code:97636-0097
Practice Address - Country:US
Practice Address - Phone:541-943-3111
Practice Address - Fax:541-943-3129
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE COUNTY SCHOOL DISTRICT #11
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency