Provider Demographics
NPI:1417988502
Name:KELSO SCHOOL DISTRICT
Entity Type:Organization
Organization Name:KELSO SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF HUMAN RESOURC
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HOTTOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-501-1917
Mailing Address - Street 1:601 CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-4315
Mailing Address - Country:US
Mailing Address - Phone:360-501-1904
Mailing Address - Fax:360-501-1965
Practice Address - Street 1:601 CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-4315
Practice Address - Country:US
Practice Address - Phone:360-501-1904
Practice Address - Fax:360-501-1965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7440084Medicaid