Provider Demographics
NPI:1609900190
Name:LAKE STATION COMMUNITY SCHOOLS
Entity Type:Organization
Organization Name:LAKE STATION COMMUNITY SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:DEHAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-962-1159
Mailing Address - Street 1:2500 PIKE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE STATION
Mailing Address - State:IN
Mailing Address - Zip Code:46405-2258
Mailing Address - Country:US
Mailing Address - Phone:219-962-1159
Mailing Address - Fax:
Practice Address - Street 1:2500 PIKE ST
Practice Address - Street 2:
Practice Address - City:LAKE STATION
Practice Address - State:IN
Practice Address - Zip Code:46405-2258
Practice Address - Country:US
Practice Address - Phone:219-962-1159
Practice Address - Fax:219-962-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)