Provider Demographics
NPI:1619366911
Name:WOOD RIVER WALDORF METHODS SCHOOL, A PUBLIC CHARTER SCHOOL, INC.
Entity Type:Organization
Organization Name:WOOD RIVER WALDORF METHODS SCHOOL, A PUBLIC CHARTER SCHOOL, INC.
Other - Org Name:SYRINGA MOUNTAIN SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GERVASE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-806-2880
Mailing Address - Street 1:4021 GLENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-8516
Mailing Address - Country:US
Mailing Address - Phone:208-806-2880
Mailing Address - Fax:208-788-2464
Practice Address - Street 1:4021 GLENBROOK DR
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8516
Practice Address - Country:US
Practice Address - Phone:208-806-2880
Practice Address - Fax:208-788-2464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-10
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)