Healthcare Provider Details

I. General information

NPI: 1609049964
Provider Name (Legal Business Name): SCHOOL DISTRICT OF CRIVITZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SOUTH AVE
CRIVITZ WI
54114-1674
US

IV. Provider business mailing address

400 SOUTH AVE
CRIVITZ WI
54114-1674
US

V. Phone/Fax

Practice location:
  • Phone: 715-854-2721
  • Fax:
Mailing address:
  • Phone: 715-854-2721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number048030
License Number StateWI

VIII. Authorized Official

Name: RON SAARI
Title or Position: DISTRICT ADMINISTRATOR
Credential:
Phone: 715-854-2721