Provider Demographics
NPI:1801800727
Name:BETHEL SCHOOL DISTRICT
Entity type:Organization
Organization Name:BETHEL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAUGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-683-6927
Mailing Address - Street 1:516 176TH ST E
Mailing Address - Street 2:INSTRUCTIONAL SUPPORT
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8335
Mailing Address - Country:US
Mailing Address - Phone:253-683-6927
Mailing Address - Fax:253-847-2067
Practice Address - Street 1:516 176TH ST E
Practice Address - Street 2:INSTRUCTIONAL SUPPORT
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8335
Practice Address - Country:US
Practice Address - Phone:253-683-6927
Practice Address - Fax:253-847-2067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7441157Medicaid