Provider Demographics
NPI:1770651754
Name:IND SCHOOL DIST 883
Entity Type:Organization
Organization Name:IND SCHOOL DIST 883
Other - Org Name:ISD #883 ROCKFORD
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-477-9165
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55373-0009
Mailing Address - Country:US
Mailing Address - Phone:763-477-9165
Mailing Address - Fax:763-477-5833
Practice Address - Street 1:6051 ASH STREET
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MN
Practice Address - Zip Code:55373-0009
Practice Address - Country:US
Practice Address - Phone:763-477-9165
Practice Address - Fax:763-477-5833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN215612100OtherMEDICAL ASSISTANCE