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? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251300000X | Agencies | Local Education Agency (LEA) |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MN | 007555800 | Medicaid |