Provider Demographics
NPI:1497857890
Name:CLE ELUM-ROSLYN SCHOOL DISTRICT
Entity Type:Organization
Organization Name:CLE ELUM-ROSLYN SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-649-2393
Mailing Address - Street 1:2694 SR 903
Mailing Address - Street 2:
Mailing Address - City:CLE ELUM
Mailing Address - State:WA
Mailing Address - Zip Code:98922
Mailing Address - Country:US
Mailing Address - Phone:509-649-3560
Mailing Address - Fax:509-649-3634
Practice Address - Street 1:2694 SR 903
Practice Address - Street 2:
Practice Address - City:CLE ELUM
Practice Address - State:WA
Practice Address - Zip Code:98922
Practice Address - Country:US
Practice Address - Phone:509-649-3560
Practice Address - Fax:509-649-3634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7442528Medicaid