Provider Demographics
NPI:1740431808
Name:GLENWOOD R-VIII SCHOOL DISTRICT
Entity Type:Organization
Organization Name:GLENWOOD R-VIII SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:A
Authorized Official - Last Name:PENDERGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-256-4849
Mailing Address - Street 1:10286 STATE ROUTE 17
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-5711
Mailing Address - Country:US
Mailing Address - Phone:417-256-4849
Mailing Address - Fax:
Practice Address - Street 1:10286 STATE ROUTE 17
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-5711
Practice Address - Country:US
Practice Address - Phone:417-256-4849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO046135251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506116706Medicaid