Provider Demographics
NPI:1417040429
Name:OCEANA INTERMEDIATE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:OCEANA INTERMEDIATE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BADE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:231-873-5651
Mailing Address - Street 1:844 S GRISWOLD ST
Mailing Address - Street 2:
Mailing Address - City:HART
Mailing Address - State:MI
Mailing Address - Zip Code:49420-9756
Mailing Address - Country:US
Mailing Address - Phone:231-873-5651
Mailing Address - Fax:
Practice Address - Street 1:844 S GRISWOLD ST
Practice Address - Street 2:
Practice Address - City:HART
Practice Address - State:MI
Practice Address - Zip Code:49420-9756
Practice Address - Country:US
Practice Address - Phone:231-873-5651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2989248Medicaid