Healthcare Provider Details

I. General information

NPI: 1053098822
Provider Name (Legal Business Name): OLDHAM-RAMONA-RUTLAND SCHOOL DISTRICT 39-6
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 SCHOOL ST
RUTLAND SD
57057-6526
US

IV. Provider business mailing address

102 SCHOOL ST
RUTLAND SD
57057-6526
US

V. Phone/Fax

Practice location:
  • Phone: 605-586-4352
  • Fax:
Mailing address:
  • Phone: 605-586-4352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL HANSEN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 605-586-4352