MEDICARE: LIBERTY SCHOOL DISTRICT

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	251300000X	Local Education Agency (LEA)		WA

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	:	1376576587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	29818 S NORTH PINE CREEK RD
Second Line	:
City	:	SPANGLE
State	:	WA
Zip	:	99031-9707
Country	:	US
Telephone Number	:	509-245-3223
Fax Number	:	509-245-3288

Provider Business Practice Location Address
First Line	:	29818 S NORTH PINE CREEK RD
Second Line	:
City	:	SPANGLE
State	:	WA
Zip	:	99031-9707
Country	:	US
Telephone Number	:	509-245-3223
Fax Number	:	509-245-3288

Authorized Official
Title or Position	:	SPECIAL SERVICES
Name	:	MRS. GRACIE P HODGSON
Credential	:
Telephone Number	:	509-245-3211

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	08/22/2020

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Directions to “LIBERTY SCHOOL DISTRICT ” Practice Location

Language	Start Address	Practice Location

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