Provider Demographics
NPI:1669401451
Name:BAKER SD 5J
Entity type:Organization
Organization Name:BAKER SD 5J
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:ULREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-524-2260
Mailing Address - Street 1:2090 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-3318
Mailing Address - Country:US
Mailing Address - Phone:541-524-2260
Mailing Address - Fax:
Practice Address - Street 1:2090 4TH ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-3318
Practice Address - Country:US
Practice Address - Phone:541-524-2260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
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
OR130549Medicaid