Provider Demographics
NPI:1922163062
Name:WADENA-DEER CREEK PUBLIC SCHOOL
Entity Type:Organization
Organization Name:WADENA-DEER CREEK PUBLIC SCHOOL
Other - Org Name:C/O ATTN SUPT
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-632-2155
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-0151
Mailing Address - Country:US
Mailing Address - Phone:218-632-2155
Mailing Address - Fax:218-631-2199
Practice Address - Street 1:520 COLFAX AVE SW
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1769
Practice Address - Country:US
Practice Address - Phone:218-632-2155
Practice Address - Fax:218-632-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN007555800Medicaid