Provider Demographics
NPI:1568770766
Name:SLIDELL ISD
Entity Type:Organization
Organization Name:SLIDELL ISD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-683-8361
Mailing Address - Street 1:1 GREYHOUND LANE
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:TX
Mailing Address - Zip Code:76267
Mailing Address - Country:US
Mailing Address - Phone:940-683-8361
Mailing Address - Fax:940-683-5849
Practice Address - Street 1:1 GREYHOUND LANE
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:TX
Practice Address - Zip Code:76267
Practice Address - Country:US
Practice Address - Phone:940-683-8361
Practice Address - Fax:940-683-5849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065070702Medicaid