Healthcare Provider Details

I. General information

NPI: 1972415917
Provider Name (Legal Business Name): SHENANDOAH SCHOOL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 N RAIDER RD
MIDDLETOWN IN
47356-9797
US

IV. Provider business mailing address

5100 N RAIDER RD
MIDDLETOWN IN
47356-9797
US

V. Phone/Fax

Practice location:
  • Phone: 765-354-2266
  • Fax:
Mailing address:
  • Phone:
  • 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: MR. JAKE WIESE
Title or Position: SUPERINTENDENT
Credential:
Phone: 765-354-2266