Provider Demographics
NPI:1801008438
Name:FORT WAYNE COMMUNITY SCHOOLS
Entity Type:Organization
Organization Name:FORT WAYNE COMMUNITY SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-467-2000
Mailing Address - Street 1:1200 S CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-3504
Mailing Address - Country:US
Mailing Address - Phone:260-467-2000
Mailing Address - Fax:260-467-1981
Practice Address - Street 1:203 E DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-3534
Practice Address - Country:US
Practice Address - Phone:260-467-1110
Practice Address - Fax:260-467-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10019740Medicaid