MEDICARE: BRUNEAU-GRAND VIEW JT. SCHOOL DISTRICT #365

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1710157128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUNEAU-GRAND VIEW JT. SCHOOL DISTRICT #365

Provider Business Mailing Address
First Line	:	PO BOX 310
Second Line	:
City	:	GRAND VIEW
State	:	ID
Zip	:	83624-0310
Country	:	US
Telephone Number	:	208-834-2253
Fax Number	:	208-834-2293

Provider Business Practice Location Address
First Line	:	660 BOISE AVENUE
Second Line	:
City	:	GRAND VIEW
State	:	ID
Zip	:	83624
Country	:	US
Telephone Number	:	208-834-2253
Fax Number	:	208-834-2293

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	VICKIE L. CHANDLER
Credential	:
Telephone Number	:	208-834-2253

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/03/2008

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