Healthcare Provider Details

I. General information

NPI: 1568652618
Provider Name (Legal Business Name): GRANITE FALLS SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 N ALDER AVE
GRANITE FALLS WA
98252-8908
US

IV. Provider business mailing address

307 N ALDER AVE
GRANITE FALLS WA
98252-8908
US

V. Phone/Fax

Practice location:
  • Phone: 360-691-7717
  • Fax: 360-691-4459
Mailing address:
  • Phone: 360-691-7717
  • Fax: 360-691-4459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number316006703
License Number StateWA

VIII. Authorized Official

Name: MR. MIKE A SULLIVAN
Title or Position: DIR OF BUSINESS AND OPERATIONS
Credential:
Phone: 360-691-7717