Provider Demographics
NPI:1245354554
Name:ELDORA-NEW PROVIDENCE COMMUNITY SCHOOL DISTRICT
Entity type:Organization
Organization Name:ELDORA-NEW PROVIDENCE COMMUNITY SCHOOL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-939-5631
Mailing Address - Street 1:1800 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ELDORA
Mailing Address - State:IA
Mailing Address - Zip Code:50627-1558
Mailing Address - Country:US
Mailing Address - Phone:319-939-5631
Mailing Address - Fax:319-939-3667
Practice Address - Street 1:1800 24TH ST
Practice Address - Street 2:
Practice Address - City:ELDORA
Practice Address - State:IA
Practice Address - Zip Code:50627-1558
Practice Address - Country:US
Practice Address - Phone:319-939-5631
Practice Address - Fax:319-939-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
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
IA0483982Medicaid