=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164500104
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DICKINSON-IRON INTERMEDIATE SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1074 PYLE DR
-----------------------------------------------------
City | KINGSFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49802-4451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-779-2692
-----------------------------------------------------
Fax | 906-779-2642
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1074 PYLE DR
-----------------------------------------------------
City | KINGSFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49802-4451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-779-2692
-----------------------------------------------------
Fax | 906-779-2642
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF SPECIAL EDUCATION
-----------------------------------------------------
Name | MR. DEAN A RUOHOMAKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 906-779-2692
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------