Provider Demographics
NPI:1205979077
Name:MONTICELLO INDEPENDENT SCHOOL
Entity type:Organization
Organization Name:MONTICELLO INDEPENDENT SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL PROGRAMS COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:G
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-348-7160
Mailing Address - Street 1:131 CAVE ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-1411
Mailing Address - Country:US
Mailing Address - Phone:606-348-7160
Mailing Address - Fax:606-348-1974
Practice Address - Street 1:131 CAVE ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-1411
Practice Address - Country:US
Practice Address - Phone:606-348-7160
Practice Address - Fax:606-348-1974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY21116025Medicaid