Provider Demographics
NPI:1689701021
Name:LOGAN MAGNOLIA SCHOOL
Entity Type:Organization
Organization Name:LOGAN MAGNOLIA SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-644-2501
Mailing Address - Street 1:1200 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:IA
Mailing Address - Zip Code:51546-1060
Mailing Address - Country:US
Mailing Address - Phone:712-644-2501
Mailing Address - Fax:
Practice Address - Street 1:1200 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:IA
Practice Address - Zip Code:51546-1060
Practice Address - Country:US
Practice Address - Phone:712-644-2501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098712251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0272005Medicaid