Healthcare Provider Details

I. General information

NPI: 1356416119
Provider Name (Legal Business Name): EDMUNDS CENTRAL SCHOOL DISTRICT #22-5
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 FIRST AVE.
ROSCOE SD
57471-0317
US

IV. Provider business mailing address

PO BOX 317
ROSCOE SD
57471-0317
US

V. Phone/Fax

Practice location:
  • Phone: 605-287-4251
  • Fax: 605-287-4581
Mailing address:
  • Phone: 605-287-4251
  • Fax: 605-287-4581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateSD

VIII. Authorized Official

Name: DEBRA SWALVE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 605-287-4251