MEDICARE: HOOD RIVER COUNTY SCHOOL DISTRICT EI/ECSE PROGRAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	251300000X	Local Education Agency (LEA)		OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275858854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOOD RIVER COUNTY SCHOOL DISTRICT EI/ECSE PROGRAM

Provider Business Mailing Address
First Line	:	1011 EUGENE ST
Second Line	:
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-1415
Country	:	US
Telephone Number	:	541-387-5010
Fax Number	:	541-387-5099

Provider Business Practice Location Address
First Line	:	455 FRANKTON RD
Second Line	:
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-9737
Country	:	US
Telephone Number	:	541-387-5077
Fax Number	:	541-387-3506

Authorized Official
Title or Position	:	BUSINESS MANAGER/DEPUTY CLERK
Name	:	MR. NICK HOGAN
Credential	:
Telephone Number	:	541-387-5010

Provider Enumeration Date	:	04/07/2010
Last Update Date	:	04/12/2010

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