Provider Demographics
NPI:1598820656
Name:INDEPENDENT SCHOOL DISTRICT 640
Entity Type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT 640
Other - Org Name:WABASSO PUBLIC SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-342-5114
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:1333 MAY ST
Mailing Address - City:WABASSO
Mailing Address - State:MN
Mailing Address - Zip Code:56293-0069
Mailing Address - Country:US
Mailing Address - Phone:507-342-5114
Mailing Address - Fax:507-342-5203
Practice Address - Street 1:1333 MAY STREET
Practice Address - Street 2:
Practice Address - City:WABASSO
Practice Address - State:MN
Practice Address - Zip Code:56293
Practice Address - Country:US
Practice Address - Phone:507-342-5114
Practice Address - Fax:507-342-5203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)