Provider Demographics
NPI:1518180165
Name:INDEPENDENT SCHOOL DISTRICT 332
Entity Type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT 332
Other - Org Name:RRSEC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUPRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-689-3600
Mailing Address - Street 1:140 BUCHANAN ST N
Mailing Address - Street 2:STE. 150
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-1638
Mailing Address - Country:US
Mailing Address - Phone:763-689-3600
Mailing Address - Fax:763-689-3601
Practice Address - Street 1:400 MAPLE AVE E
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1334
Practice Address - Country:US
Practice Address - Phone:320-679-6201
Practice Address - Fax:320-679-6209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8005749251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN680032700Medicaid