Provider Demographics
NPI:1649459637
Name:JT SCHOOL DIST NO 1
Entity type:Organization
Organization Name:JT SCHOOL DIST NO 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-889-4384
Mailing Address - Street 1:300 E PROSSER ST
Mailing Address - Street 2:P.O. BOX 69
Mailing Address - City:SILVER LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53170-1409
Mailing Address - Country:US
Mailing Address - Phone:262-889-4384
Mailing Address - Fax:262-889-8450
Practice Address - Street 1:300 E PROSSER ST
Practice Address - Street 2:
Practice Address - City:SILVER LAKE
Practice Address - State:WI
Practice Address - Zip Code:53170-1409
Practice Address - Country:US
Practice Address - Phone:262-889-4384
Practice Address - Fax:262-889-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44204400Medicaid