Healthcare Provider Details

I. General information

NPI: 1124440649
Provider Name (Legal Business Name): PANDORA-GILBOA LOCAL SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 ROCKET RDG
PANDORA OH
45877-9607
US

IV. Provider business mailing address

410 ROCKET RDG
PANDORA OH
45877-9607
US

V. Phone/Fax

Practice location:
  • Phone: 419-384-3227
  • 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: BRAD DELERUYELLE
Title or Position: TREASURER
Credential:
Phone: 419-384-3230