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General NPI Number Information
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NPI Number | 1386795623
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Entity Type | Organization
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Legal Business Name | PELLA CSD
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 210 E UNIVERSITY ST
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City | PELLA
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State | IA
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Zip | 50219-1970
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Country | US
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Telephone | 641-628-1111
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Fax | 641-628-1116
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Provider Business Mailing Address
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Address Line | 210 E UNIVERSITY ST
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City | PELLA
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State | IA
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Zip | 50219-1970
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Country | US
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Telephone | 641-628-1111
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Fax | 641-628-1116
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Authorized Official
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Title or Position | SUPERINTENDENT
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Name | MARK J WITTMER
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Credential |
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Telephone | 641-628-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State | IA
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