Provider Demographics
NPI:1669501573
Name:THREE FORKS PUBLIC SCHOOLS
Entity Type:Organization
Organization Name:THREE FORKS PUBLIC SCHOOLS
Other - Org Name:SCHOOL DISTRICT RELATED SERVICES-THREE FORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST.. SUPERINTENDENT OF BUSINESS
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-522-6042
Mailing Address - Street 1:212 E NEAL ST
Mailing Address - Street 2:
Mailing Address - City:THREE FORKS
Mailing Address - State:MT
Mailing Address - Zip Code:59752-9300
Mailing Address - Country:US
Mailing Address - Phone:406-522-6011
Mailing Address - Fax:406-522-6090
Practice Address - Street 1:212 E NEAL ST
Practice Address - Street 2:
Practice Address - City:THREE FORKS
Practice Address - State:MT
Practice Address - Zip Code:59752-9300
Practice Address - Country:US
Practice Address - Phone:406-522-6011
Practice Address - Fax:406-522-6090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0165243Medicaid