Provider Demographics
NPI:1528204575
Name:CHAMBERLAIN SCHOOL DISTRICT
Entity Type:Organization
Organization Name:CHAMBERLAIN SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-234-4477
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:CHAMBERLAIN
Mailing Address - State:SD
Mailing Address - Zip Code:57325-0119
Mailing Address - Country:US
Mailing Address - Phone:605-234-4477
Mailing Address - Fax:605-234-4479
Practice Address - Street 1:612 MAIN AVE
Practice Address - Street 2:
Practice Address - City:PLATTE
Practice Address - State:SD
Practice Address - Zip Code:57369-2117
Practice Address - Country:US
Practice Address - Phone:605-337-2636
Practice Address - Fax:605-337-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD251300000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5150740Medicaid