Provider Demographics
NPI:1669669131
Name:CLARK SCHOOL DIST 12 2
Entity Type:Organization
Organization Name:CLARK SCHOOL DIST 12 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARICE
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:DRENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-532-3604
Mailing Address - Street 1:220 N CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:SD
Mailing Address - Zip Code:57225
Mailing Address - Country:US
Mailing Address - Phone:605-532-3604
Mailing Address - Fax:605-532-3600
Practice Address - Street 1:209 MAIN AVE
Practice Address - Street 2:NESC
Practice Address - City:HAYTI
Practice Address - State:SD
Practice Address - Zip Code:57241
Practice Address - Country:US
Practice Address - Phone:605-783-3607
Practice Address - Fax:605-783-3259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5150320Medicaid