Provider Demographics
NPI:1770859530
Name:NORTHERN LIGHTS COMMUNITY SCHOOL
Entity type:Organization
Organization Name:NORTHERN LIGHTS COMMUNITY SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-492-4400
Mailing Address - Street 1:PO BOX 2829
Mailing Address - Street 2:
Mailing Address - City:WARBA
Mailing Address - State:MN
Mailing Address - Zip Code:55793-2829
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 BRIDGE STREET
Practice Address - Street 2:
Practice Address - City:WARBA
Practice Address - State:MN
Practice Address - Zip Code:55793-2829
Practice Address - Country:US
Practice Address - Phone:218-492-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)