Provider Demographics
NPI:1477870657
Name:CULDESAC JOINT SCHOOL DISTRICT #342
Entity Type:Organization
Organization Name:CULDESAC JOINT SCHOOL DISTRICT #342
Other - Org Name:COUNTY OF NEZPERCE
Other - Org Type:Other Name
Authorized Official - Title/Position:SCHOOL PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-843-5413
Mailing Address - Street 1:600 CULDESAC AVE
Mailing Address - Street 2:ATTN: PRINCIPAL HUSSMAN
Mailing Address - City:CULDESAC
Mailing Address - State:ID
Mailing Address - Zip Code:83524
Mailing Address - Country:US
Mailing Address - Phone:208-843-5413
Mailing Address - Fax:208-843-2719
Practice Address - Street 1:600 CULDESAC AVE
Practice Address - Street 2:
Practice Address - City:CULDESAC
Practice Address - State:ID
Practice Address - Zip Code:83524-8700
Practice Address - Country:US
Practice Address - Phone:208-843-5413
Practice Address - Fax:208-843-2719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805102000OtherIDAHO MEDICAID PROVIDER NUMBER