Provider Demographics
NPI:1518057751
Name:CASS & CROW WINGS COS IND SCHOOL DIST 2174
Entity Type:Organization
Organization Name:CASS & CROW WINGS COS IND SCHOOL DIST 2174
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THIRD PARTY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-454-5532
Mailing Address - Street 1:804 OAK ST.
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401
Mailing Address - Country:US
Mailing Address - Phone:218-454-5532
Mailing Address - Fax:218-828-2148
Practice Address - Street 1:401 MURRAY AVENUE
Practice Address - Street 2:
Practice Address - City:PINE RIVER
Practice Address - State:MN
Practice Address - Zip Code:56474
Practice Address - Country:US
Practice Address - Phone:218-587-8000
Practice Address - Fax:218-587-4721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN649670900Medicare ID - Type Unspecified