Provider Demographics
NPI:1265450449
Name:OKANOGAN SCHOOL DISTRICT #105
Entity type:Organization
Organization Name:OKANOGAN SCHOOL DISTRICT #105
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-422-3629
Mailing Address - Street 1:1118 SOUTH FIFTH ST
Mailing Address - Street 2:PO BOX 592
Mailing Address - City:OKANOGAN
Mailing Address - State:WA
Mailing Address - Zip Code:98840
Mailing Address - Country:US
Mailing Address - Phone:509-422-3580
Mailing Address - Fax:509-422-1639
Practice Address - Street 1:1118 SOUTH FIFTH ST
Practice Address - Street 2:
Practice Address - City:OKANOGAN
Practice Address - State:WA
Practice Address - Zip Code:98840
Practice Address - Country:US
Practice Address - Phone:509-422-3580
Practice Address - Fax:509-422-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
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
WA7441934Medicaid