Healthcare Provider Details

I. General information

NPI: 1316024219
Provider Name (Legal Business Name): SERGEANT BLUFF-LUTON COMMUNITY SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PORT NEAL RD
SERGEANT BLUFF IA
51054-0097
US

IV. Provider business mailing address

201 PORT NEAL RD P O BOX 97
SERGEANT BLUFF IA
51054-0097
US

V. Phone/Fax

Practice location:
  • Phone: 712-943-4338
  • Fax: 712-943-1131
Mailing address:
  • Phone: 712-943-4338
  • Fax: 712-943-1131

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: SUSAN J MOHR
Title or Position: BUSINESS MANAGER
Credential:
Phone: 712-943-4338