Provider Demographics
NPI:1710297890
Name:WEST WASHINGTON SCHOOL CORPORATION
Entity Type:Organization
Organization Name:WEST WASHINGTON SCHOOL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-723-2089
Mailing Address - Street 1:9699 W MOUNT TABOR RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47108-8560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9699 W MOUNT TABOR RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSBURG
Practice Address - State:IN
Practice Address - Zip Code:47108-8560
Practice Address - Country:US
Practice Address - Phone:812-723-2089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100197390Medicaid