Provider Demographics
NPI:1801077292
Name:RACINE UNIFIED SCHOOL DISTRICT
Entity type:Organization
Organization Name:RACINE UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-631-7113
Mailing Address - Street 1:2220 NORTHWESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53404-2519
Mailing Address - Country:US
Mailing Address - Phone:262-635-5600
Mailing Address - Fax:262-619-4624
Practice Address - Street 1:2220 NORTHWESTERN AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53404-2519
Practice Address - Country:US
Practice Address - Phone:262-635-5600
Practice Address - Fax:262-619-4624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44211100Medicaid