Provider Demographics
NPI:1457437519
Name:LAKE BENTON ISD #404
Entity type:Organization
Organization Name:LAKE BENTON ISD #404
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DONNITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-368-4235
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:LAKE BENTON
Mailing Address - State:MN
Mailing Address - Zip Code:56149-0158
Mailing Address - Country:US
Mailing Address - Phone:507-368-4235
Mailing Address - Fax:507-368-4477
Practice Address - Street 1:101 S GARFIELD ST
Practice Address - Street 2:
Practice Address - City:LAKE BENTON
Practice Address - State:MN
Practice Address - Zip Code:56149
Practice Address - Country:US
Practice Address - Phone:507-368-4235
Practice Address - Fax:507-368-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)