Provider Demographics
NPI:1598956765
Name:BERLIN AREA SCHOOL DISTRICT
Entity Type:Organization
Organization Name:BERLIN AREA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-361-2004
Mailing Address - Street 1:295 E MARQUETTE ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-1272
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:920-361-2170
Practice Address - Street 1:295 E MARQUETTE ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-1272
Practice Address - Country:US
Practice Address - Phone:920-361-2004
Practice Address - Fax:920-361-2170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44226200Medicaid