Provider Demographics
NPI:1740290006
Name:INDEPENDENT SCHOOL DISTRICT 200
Entity type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT 200
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:CORINNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-480-7009
Mailing Address - Street 1:1000 11TH ST W
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-3717
Mailing Address - Country:US
Mailing Address - Phone:651-480-7009
Mailing Address - Fax:651-480-7020
Practice Address - Street 1:1000 11TH ST W
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-3717
Practice Address - Country:US
Practice Address - Phone:651-480-7009
Practice Address - Fax:651-480-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN326758000Medicaid