Provider Demographics
NPI:1710077516
Name:CRESCENT SCHOOL DISTRICT
Entity Type:Organization
Organization Name:CRESCENT SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-928-3311
Mailing Address - Street 1:50350 HIGHWAY 112
Mailing Address - Street 2:PO BOX 20
Mailing Address - City:JOYCE
Mailing Address - State:WA
Mailing Address - Zip Code:98343
Mailing Address - Country:US
Mailing Address - Phone:360-928-3311
Mailing Address - Fax:
Practice Address - Street 1:50350 HIGHWAY 112
Practice Address - Street 2:
Practice Address - City:JOYCE
Practice Address - State:WA
Practice Address - Zip Code:98343
Practice Address - Country:US
Practice Address - Phone:360-928-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7442049Medicaid