Provider Demographics
NPI:1710034244
Name:EAGLE GROVE C.S.D.
Entity Type:Organization
Organization Name:EAGLE GROVE C.S.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-448-4749
Mailing Address - Street 1:216 N COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:EAGLE GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:50533-1722
Mailing Address - Country:US
Mailing Address - Phone:515-448-4749
Mailing Address - Fax:
Practice Address - Street 1:216 N COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:EAGLE GROVE
Practice Address - State:IA
Practice Address - Zip Code:50533-1722
Practice Address - Country:US
Practice Address - Phone:515-448-4749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0425256Medicaid