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General NPI Number Information
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NPI Number | 1619366911
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Entity Type | Organization
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Legal Business Name | WOOD RIVER WALDORF METHODS SCHOOL, A PUBLIC CHARTER SCHOOL, INC.
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Dates
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Enumeration Date | 01/10/2015
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Last Update Date | 01/10/2015
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Provider Practice Location Address
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Address Line | 4021 GLENBROOK DR
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City | HAILEY
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State | ID
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Zip | 83333-8516
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Country | US
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Telephone | 208-806-2880
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Fax | 208-788-2464
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Provider Business Mailing Address
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Address Line | 4021 GLENBROOK DR
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City | HAILEY
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State | ID
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Zip | 83333-8516
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Country | US
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Telephone | 208-806-2880
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Fax | 208-788-2464
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MARY GERVASE
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Credential | PHD
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Telephone | 208-806-2880
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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 |
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