Healthcare Provider Details

I. General information

NPI: 1174639728
Provider Name (Legal Business Name): LEWIS CASS INTERMEDIATE SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61682 DAILEY ROAD
CASSOPOLIS MI
49031
US

IV. Provider business mailing address

61682 DAILEY ROAD
CASSOPOLIS MI
49031
US

V. Phone/Fax

Practice location:
  • Phone: 269-445-6286
  • Fax: 269-445-2981
Mailing address:
  • Phone: 269-445-6286
  • Fax: 269-445-2981

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: MRS. LAURA L. ASH
Title or Position: CHIEF FINANCIAL OFFI
Credential:
Phone: 269-445-6202