Provider Demographics
NPI:1922120724
Name:BLISS SCHOOL DISTRICT
Entity Type:Organization
Organization Name:BLISS SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-352-4447
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:601 EAST MAIN STREET
Mailing Address - City:BLISS
Mailing Address - State:ID
Mailing Address - Zip Code:83314-0115
Mailing Address - Country:US
Mailing Address - Phone:208-352-4447
Mailing Address - Fax:208-352-4649
Practice Address - Street 1:601 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:BLISS
Practice Address - State:ID
Practice Address - Zip Code:83314-0115
Practice Address - Country:US
Practice Address - Phone:208-352-4447
Practice Address - Fax:208-352-4649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8051259251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8051259Medicaid