Provider Demographics
NPI:1801968938
Name:IND SCHOOL DIST NO 803 - TRAVERSE CO
Entity type:Organization
Organization Name:IND SCHOOL DIST NO 803 - TRAVERSE CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:POSTHUMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-563-8282
Mailing Address - Street 1:1700 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MN
Mailing Address - Zip Code:56296-1696
Mailing Address - Country:US
Mailing Address - Phone:320-563-8282
Mailing Address - Fax:320-563-4218
Practice Address - Street 1:1700 3RD AVE S
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MN
Practice Address - Zip Code:56296-1696
Practice Address - Country:US
Practice Address - Phone:320-563-8282
Practice Address - Fax:320-563-4218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN769455500Medicaid