Provider Demographics
NPI:1417967621
Name:IN SCHL DIST 485 ROYALTON PUB SCH
Entity Type:Organization
Organization Name:IN SCHL DIST 485 ROYALTON PUB SCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DALCHOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-584-5531
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:ROYALTON
Mailing Address - State:MN
Mailing Address - Zip Code:56373
Mailing Address - Country:US
Mailing Address - Phone:320-584-5531
Mailing Address - Fax:320-584-5218
Practice Address - Street 1:120 S HAWTHORN STREET
Practice Address - Street 2:
Practice Address - City:ROYALTON
Practice Address - State:MN
Practice Address - Zip Code:56373
Practice Address - Country:US
Practice Address - Phone:320-584-5531
Practice Address - Fax:320-584-5218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN804645000Medicaid