Healthcare Provider Details

I. General information

NPI: 1437189669
Provider Name (Legal Business Name): COULEE-HARTLINE SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W LOCUST ST
COULEE CITY WA
99115
US

IV. Provider business mailing address

410 W LOCUST ST PO BOX 428
COULEE CITY WA
99115
US

V. Phone/Fax

Practice location:
  • Phone: 509-632-5231
  • Fax: 509-632-5166
Mailing address:
  • Phone: 509-632-5231
  • Fax: 509-632-5166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. EDWARD A FISK
Title or Position: SUPERINTENDENT
Credential: ED.D.
Phone: 509-632-5231