Provider Demographics
NPI:1760413926
Name:GRAND COULEE DAM SCHOOL DISTRICT
Entity Type:Organization
Organization Name:GRAND COULEE DAM SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT/BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:LOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-633-2143
Mailing Address - Street 1:110 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:COULEE DAM
Mailing Address - State:WA
Mailing Address - Zip Code:99116-1426
Mailing Address - Country:US
Mailing Address - Phone:509-633-2143
Mailing Address - Fax:
Practice Address - Street 1:110 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:COULEE DAM
Practice Address - State:WA
Practice Address - Zip Code:99116-1426
Practice Address - Country:US
Practice Address - Phone:509-633-2143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
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
WA7441371Medicaid