Provider Demographics
NPI:1770649915
Name:IND SCHOOL DIST 624
Entity Type:Organization
Organization Name:IND SCHOOL DIST 624
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF HR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-407-7550
Mailing Address - Street 1:4855 BLOOM AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-2731
Mailing Address - Country:US
Mailing Address - Phone:651-407-7568
Mailing Address - Fax:
Practice Address - Street 1:4855 BLOOM AVE
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-2731
Practice Address - Country:US
Practice Address - Phone:651-407-7568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-30
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN530678700Medicaid