Provider Demographics
NPI:1083866214
Name:DUNKLIN R-5 SCHOOL DISTRICT
Entity type:Organization
Organization Name:DUNKLIN R-5 SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-479-5200
Mailing Address - Street 1:497 JOACHIM AVE
Mailing Address - Street 2:
Mailing Address - City:HERCULANEUM
Mailing Address - State:MO
Mailing Address - Zip Code:63048-1034
Mailing Address - Country:US
Mailing Address - Phone:636-479-5200
Mailing Address - Fax:636-479-2053
Practice Address - Street 1:497 JOACHIM AVE
Practice Address - Street 2:
Practice Address - City:HERCULANEUM
Practice Address - State:MO
Practice Address - Zip Code:63048-1034
Practice Address - Country:US
Practice Address - Phone:636-479-5200
Practice Address - Fax:636-479-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO466146800Medicaid