Provider Demographics
NPI:1942235064
Name:MANSFIELD SCHOOL DISTRICT #207
Entity Type:Organization
Organization Name:MANSFIELD SCHOOL DISTRICT #207
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:509-683-1012
Mailing Address - Street 1:STATE HIGHWAY 172
Mailing Address - Street 2:PO BOX 188
Mailing Address - City:MANFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98830-0188
Mailing Address - Country:US
Mailing Address - Phone:509-683-1012
Mailing Address - Fax:509-683-1281
Practice Address - Street 1:STATE HIGHWAY 172
Practice Address - Street 2:
Practice Address - City:MANFIELD
Practice Address - State:WA
Practice Address - Zip Code:98830-0188
Practice Address - Country:US
Practice Address - Phone:509-683-1012
Practice Address - Fax:509-683-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7441066Medicaid