Healthcare Provider Details

I. General information

NPI: 1023035870
Provider Name (Legal Business Name): COUNCIL BLUFFS COMMUNITY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SCOTT ST
COUNCIL BLUFFS IA
51503-0782
US

IV. Provider business mailing address

12 SCOTT ST
COUNCIL BLUFFS IA
51503-0782
US

V. Phone/Fax

Practice location:
  • Phone: 712-328-6400
  • Fax: 712-328-6488
Mailing address:
  • Phone: 712-328-6400
  • Fax: 712-328-6488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateIA

VIII. Authorized Official

Name: MR. RONALD J DIIMIG
Title or Position: SUPERVISOR OF STUDENT SERVICES
Credential:
Phone: 712-328-6430