MEDICARE: BENTON-CARROLL-SALEM LSD

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)

General Provider Information

NPI Number	:	1790982890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENTON-CARROLL-SALEM LSD

Provider Business Mailing Address
First Line	:	11685 W. ST RT 163
Second Line	:
City	:	OAK HARBOR
State	:	OH
Zip	:	43449
Country	:	US
Telephone Number	:	419-898-6210
Fax Number	:	419-898-4303

Provider Business Practice Location Address
First Line	:	11685 W STATE ROUTE 163
Second Line	:
City	:	OAK HARBOR
State	:	OH
Zip	:	43449-1278
Country	:	US
Telephone Number	:	419-898-6210
Fax Number	:	419-898-4303

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MRS. DIANE KERSHAW
Credential	:
Telephone Number	:	419-898-6210

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	08/22/2020

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