Provider Demographics
NPI:1801964796
Name:INDEPENDENT SCHOOL DISTRICT NO 2687
Entity type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT NO 2687
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:LADD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-543-3521
Mailing Address - Street 1:801 8TH AVENUE SOUTH
Mailing Address - Street 2:BOX 708
Mailing Address - City:HOWARD LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55349-0708
Mailing Address - Country:US
Mailing Address - Phone:320-543-3521
Mailing Address - Fax:320-543-3590
Practice Address - Street 1:801 8TH AVE SOUTH
Practice Address - Street 2:BOX 708
Practice Address - City:HOWARD LAKE
Practice Address - State:MN
Practice Address - Zip Code:55349-0708
Practice Address - Country:US
Practice Address - Phone:320-543-3521
Practice Address - Fax:320-543-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN443997000OtherMEDICAL ASSISTANCE