Healthcare Provider Details

I. General information

NPI: 1225105406
Provider Name (Legal Business Name): INDEPENDENT SCHOOL DISTRICT 879
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ELM AVE E
DELANO MN
55328-8236
US

IV. Provider business mailing address

700 ELM AVE E
DELANO MN
55328-8236
US

V. Phone/Fax

Practice location:
  • Phone: 763-972-3365
  • Fax: 763-972-6706
Mailing address:
  • Phone: 763-972-3365
  • Fax: 763-972-6706

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: JOHN SWEET
Title or Position: SUPERINTENDENT
Credential: DOCTOR
Phone: 763-972-3365