Provider Demographics
NPI:1780618819
Name:BERRIEN COUNTY INTERMEDIATE SCHOOL DISTRICT
Entity type:Organization
Organization Name:BERRIEN COUNTY INTERMEDIATE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-471-7725
Mailing Address - Street 1:711 ST JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1583
Mailing Address - Country:US
Mailing Address - Phone:269-471-1772
Mailing Address - Fax:269-471-2941
Practice Address - Street 1:711 SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1583
Practice Address - Country:US
Practice Address - Phone:269-471-1772
Practice Address - Fax:269-471-2941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
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
MI2989239Medicaid