Provider Demographics
NPI:1508134297
Name:BIRCH GROVE COMMUNITY SCHOOL
Entity Type:Organization
Organization Name:BIRCH GROVE COMMUNITY SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-663-0170
Mailing Address - Street 1:PO BOX 2242
Mailing Address - Street 2:
Mailing Address - City:TOFTE
Mailing Address - State:MN
Mailing Address - Zip Code:55615-2242
Mailing Address - Country:US
Mailing Address - Phone:218-663-0170
Mailing Address - Fax:
Practice Address - Street 1:9 GOODNEIGHBOR HILL ROAD
Practice Address - Street 2:
Practice Address - City:TOFT
Practice Address - State:MN
Practice Address - Zip Code:55615
Practice Address - Country:US
Practice Address - Phone:218-663-0170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7491217251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)