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General NPI Number Information
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NPI Number | 1770859530
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Entity Type | Organization
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Legal Business Name | NORTHERN LIGHTS COMMUNITY SCHOOL
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 305 BRIDGE STREET
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City | WARBA
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State | MN
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Zip | 55793-2829
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Country | US
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Telephone | 218-492-4400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2829
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City | WARBA
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State | MN
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Zip | 55793-2829
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DAVE HAGMAN
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Credential |
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Telephone | 218-492-4400
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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 | MN
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