Provider Demographics
NPI:1568652618
Name:GRANITE FALLS SCHOOL DISTRICT
Entity Type:Organization
Organization Name:GRANITE FALLS SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF BUSINESS AND OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-691-7717
Mailing Address - Street 1:307 N ALDER AVE
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:98252-8908
Mailing Address - Country:US
Mailing Address - Phone:360-691-7717
Mailing Address - Fax:360-691-4459
Practice Address - Street 1:307 N ALDER AVE
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:WA
Practice Address - Zip Code:98252-8908
Practice Address - Country:US
Practice Address - Phone:360-691-7717
Practice Address - Fax:360-691-4459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA316006703251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7441694Medicaid