Provider Demographics
NPI:1790878312
Name:COUNTY OF CURRY BROOKINGS HARBOR SCHOOL DISTRICT 17C
Entity Type:Organization
Organization Name:COUNTY OF CURRY BROOKINGS HARBOR SCHOOL DISTRICT 17C
Other - Org Name:BROOKINGS HARBOR SCHOOL DISTRICT 17C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-469-7443
Mailing Address - Street 1:564 FERN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415
Mailing Address - Country:US
Mailing Address - Phone:541-469-7443
Mailing Address - Fax:541-469-6599
Practice Address - Street 1:564 FERN AVE
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415
Practice Address - Country:US
Practice Address - Phone:541-469-7443
Practice Address - Fax:541-469-6599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR170427Medicaid