Provider Demographics
NPI:1710183298
Name:GASCONADE C-4 SCHOOL
Entity Type:Organization
Organization Name:GASCONADE C-4 SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-532-4821
Mailing Address - Street 1:32959 HWY 32
Mailing Address - Street 2:
Mailing Address - City:FALCON
Mailing Address - State:MO
Mailing Address - Zip Code:65470-8513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:417-532-0615
Practice Address - Street 1:32959 HWY 32
Practice Address - Street 2:
Practice Address - City:FALCON
Practice Address - State:MO
Practice Address - Zip Code:65470-8513
Practice Address - Country:US
Practice Address - Phone:417-532-4821
Practice Address - Fax:417-532-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)