Provider Demographics
NPI:1861674079
Name:TIMBER LAKE SCHOOL
Entity Type:Organization
Organization Name:TIMBER LAKE SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-466-2206
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:TIMBER LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57656
Mailing Address - Country:US
Mailing Address - Phone:605-466-2206
Mailing Address - Fax:605-466-2207
Practice Address - Street 1:503 N MAIN
Practice Address - Street 2:
Practice Address - City:ISABEL
Practice Address - State:SD
Practice Address - Zip Code:57633-0035
Practice Address - Country:US
Practice Address - Phone:605-466-2206
Practice Address - Fax:605-466-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDW4510Medicaid
SD90899Medicaid
SD92507Medicaid
SD97799Medicaid