Provider Demographics
NPI:1750430674
Name:GLADBROOK REINBECK COMMUNITY SCHOOL DISTRICT
Entity type:Organization
Organization Name:GLADBROOK REINBECK COMMUNITY SCHOOL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MODLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-345-2712
Mailing Address - Street 1:300 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:REINBECK
Mailing Address - State:IA
Mailing Address - Zip Code:50669-1428
Mailing Address - Country:US
Mailing Address - Phone:319-345-2712
Mailing Address - Fax:319-345-2242
Practice Address - Street 1:300 CEDAR ST
Practice Address - Street 2:
Practice Address - City:REINBECK
Practice Address - State:IA
Practice Address - Zip Code:50669-1428
Practice Address - Country:US
Practice Address - Phone:319-345-2712
Practice Address - Fax:319-345-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
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
IA0431809Medicaid