Provider Demographics
NPI:1477001808
Name:LUTHERAN CHURCH MISSOURI SYNOD GRACE LUTHERAN SCHOOL
Entity Type:Organization
Organization Name:LUTHERAN CHURCH MISSOURI SYNOD GRACE LUTHERAN SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-237-4142
Mailing Address - Street 1:1350 BALDY AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-7104
Mailing Address - Country:US
Mailing Address - Phone:208-237-4142
Mailing Address - Fax:
Practice Address - Street 1:1350 BALDY AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-7104
Practice Address - Country:US
Practice Address - Phone:208-237-4142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)