=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952427015
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALBIA C.S.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 BENTON AVE E
-----------------------------------------------------
City | ALBIA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52531-2035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-932-5165
-----------------------------------------------------
Fax | 641-932-5192
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 BENTON AVE E
-----------------------------------------------------
City | ALBIA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52531-2035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-932-5165
-----------------------------------------------------
Fax | 641-932-5192
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | PEGGY NEWMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 641-932-5165
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------