Provider Demographics
NPI:1467474445
Name:EATON INTERMEDIATE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:EATON INTERMEDIATE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-543-5500
Mailing Address - Street 1:1790 PACKARD HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-9717
Mailing Address - Country:US
Mailing Address - Phone:517-543-5500
Mailing Address - Fax:517-543-5166
Practice Address - Street 1:1790 PACKARD HWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-9717
Practice Address - Country:US
Practice Address - Phone:517-543-5500
Practice Address - Fax:517-543-5166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2981894Medicaid