Healthcare Provider Details

I. General information

NPI: 1538240155
Provider Name (Legal Business Name): TAHOLAH SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CHITWHIN DRIVE
TAHOLAH WA
98587
US

IV. Provider business mailing address

600 CHITWHIN DRIVE PO BOX 249
TAHOLAH WA
98587
US

V. Phone/Fax

Practice location:
  • Phone: 360-276-4729
  • Fax: 360-276-4370
Mailing address:
  • Phone: 360-276-4729
  • Fax: 360-276-4370

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. ROBERT A BOYLE
Title or Position: SUPERINTENDENT
Credential:
Phone: 360-276-4780