Provider Demographics
NPI:1508055831
Name:HENRY SCHOOL DISTRICT 14 2
Entity Type:Organization
Organization Name:HENRY SCHOOL DISTRICT 14 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:EASTHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-532-5364
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:111 NORTH CEDAR STREET
Mailing Address - City:HENRY
Mailing Address - State:SD
Mailing Address - Zip Code:57243-0008
Mailing Address - Country:US
Mailing Address - Phone:605-532-5364
Mailing Address - Fax:605-532-3795
Practice Address - Street 1:111 NORTH CEDAR STREET
Practice Address - Street 2:
Practice Address - City:HENRY
Practice Address - State:SD
Practice Address - Zip Code:57243-0008
Practice Address - Country:US
Practice Address - Phone:605-532-5364
Practice Address - Fax:605-532-3795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5150410Medicaid