=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598805723
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TWIN LAKES SCHOOL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 08/30/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 565 S MAIN STREET
-----------------------------------------------------
City | MONTICELLO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-583-7211
-----------------------------------------------------
Fax | 574-583-8963
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 565 S MAIN STREET
-----------------------------------------------------
City | MONTICELLO
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-583-7211
-----------------------------------------------------
Fax | 574-583-8963
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERINTENDENT
-----------------------------------------------------
Name | THOMAS FLETCHER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 574-583-8963
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------