Provider Demographics
NPI:1750390720
Name:GENESEE INTERMEDIATE SCHOOL DISTRICT
Entity type:Organization
Organization Name:GENESEE INTERMEDIATE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR, STUDENT DATA MANAGEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-591-4936
Mailing Address - Street 1:2413 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3429
Mailing Address - Country:US
Mailing Address - Phone:810-591-4936
Mailing Address - Fax:810-591-4440
Practice Address - Street 1:2413 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3429
Practice Address - Country:US
Practice Address - Phone:810-591-4936
Practice Address - Fax:810-591-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
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
MI2933903Medicare ID - Type Unspecified