Provider Demographics
NPI:1689853657
Name:RANDALL JOINT #1 SCHOOL DISTRICT
Entity Type:Organization
Organization Name:RANDALL JOINT #1 SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-537-2211
Mailing Address - Street 1:37101 87TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-8596
Mailing Address - Country:US
Mailing Address - Phone:262-537-2211
Mailing Address - Fax:262-537-2280
Practice Address - Street 1:37101 87TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-8596
Practice Address - Country:US
Practice Address - Phone:262-537-2211
Practice Address - Fax:262-537-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44206600Medicaid