=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376687988
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRI-CREEK SCHOOL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 195 W OAKLEY AVE
-----------------------------------------------------
City | LOWELL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46356-2206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-696-6661
-----------------------------------------------------
Fax | 219-696-2150
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 195 W OAKLEY AVE
-----------------------------------------------------
City | LOWELL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46356-2206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-696-6661
-----------------------------------------------------
Fax | 219-696-2150
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FISCAL OFFICER
-----------------------------------------------------
Name | SANDRA K GOSS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 219-696-6661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------