Provider Demographics
NPI:1922215904
Name:POPLAR ELEMENTARY SCHOOL
Entity Type:Organization
Organization Name:POPLAR ELEMENTARY SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR SPECIAL EDUCATION
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WHISENHUNT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-768-5603
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255-0458
Mailing Address - Country:US
Mailing Address - Phone:406-768-5603
Mailing Address - Fax:406-768-3475
Practice Address - Street 1:400 4TH AVE. WEST
Practice Address - Street 2:
Practice Address - City:POPLAR
Practice Address - State:MT
Practice Address - Zip Code:59255-0458
Practice Address - Country:US
Practice Address - Phone:406-768-5603
Practice Address - Fax:406-768-3475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0166010Medicaid