Provider Demographics
NPI:1669554564
Name:INDEPENDENT SCHOOL DISTRICT #435
Entity type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT #435
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-473-6171
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:WAUBUN
Mailing Address - State:MN
Mailing Address - Zip Code:56589
Mailing Address - Country:US
Mailing Address - Phone:218-473-6171
Mailing Address - Fax:218-473-6191
Practice Address - Street 1:1013 3RD ST
Practice Address - Street 2:
Practice Address - City:WAUBUN
Practice Address - State:MN
Practice Address - Zip Code:56589
Practice Address - Country:US
Practice Address - Phone:218-473-6171
Practice Address - Fax:218-473-6191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN196663400Medicaid