Provider Demographics
NPI:1720009988
Name:IREDELL-STATESVILLE SCHOOLS
Entity Type:Organization
Organization Name:IREDELL-STATESVILLE SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF EXC CHILDREN SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-873-9432
Mailing Address - Street 1:100 EUROPA DR STE 290
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-2310
Mailing Address - Country:US
Mailing Address - Phone:919-942-9448
Mailing Address - Fax:919-942-7213
Practice Address - Street 1:410 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-6142
Practice Address - Country:US
Practice Address - Phone:704-872-3158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
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
NC8600030Medicaid