Provider Demographics
NPI:1750310405
Name:CENTRALIA SCHOOL DISTRICT
Entity Type:Organization
Organization Name:CENTRALIA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAGBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-807-7245
Mailing Address - Street 1:1265 SW PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-3624
Mailing Address - Country:US
Mailing Address - Phone:360-807-7245
Mailing Address - Fax:360-748-8767
Practice Address - Street 1:1265 SW PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3624
Practice Address - Country:US
Practice Address - Phone:360-807-7245
Practice Address - Fax:360-748-8767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
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
WA7442270Medicaid