Healthcare Provider Details

I. General information

NPI: 1083761571
Provider Name (Legal Business Name): OKOBOJI C.S.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 7TH ST
MILFORD IA
51351-1724
US

IV. Provider business mailing address

1205 7TH ST
MILFORD IA
51351-1724
US

V. Phone/Fax

Practice location:
  • Phone: 712-338-4757
  • Fax:
Mailing address:
  • Phone: 712-338-4757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BOB MILLER
Title or Position: SUPERINTENDENT
Credential:
Phone: 712-338-4757