Provider Demographics
NPI:1558540831
Name:MARCUS-MERIDEN-CLEGHORN CSD
Entity Type:Organization
Organization Name:MARCUS-MERIDEN-CLEGHORN CSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDHORST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-376-4171
Mailing Address - Street 1:400 E FENTON ST
Mailing Address - Street 2:PO BOX 667
Mailing Address - City:MARCUS
Mailing Address - State:IA
Mailing Address - Zip Code:51035-7779
Mailing Address - Country:US
Mailing Address - Phone:712-376-4171
Mailing Address - Fax:712-376-4302
Practice Address - Street 1:400 E FENTON ST
Practice Address - Street 2:
Practice Address - City:MARCUS
Practice Address - State:IA
Practice Address - Zip Code:51035-7779
Practice Address - Country:US
Practice Address - Phone:712-376-4171
Practice Address - Fax:712-376-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0422485Medicaid