Provider Demographics
NPI:1174703029
Name:JOHNSON CREEK SCHOOL DISTRICT
Entity type:Organization
Organization Name:JOHNSON CREEK SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-699-2811
Mailing Address - Street 1:111 SOUTH ST
Mailing Address - Street 2:PO BOX 39
Mailing Address - City:JOHNSON CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53038-9702
Mailing Address - Country:US
Mailing Address - Phone:920-699-2811
Mailing Address - Fax:920-699-2801
Practice Address - Street 1:111 SOUTH ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CREEK
Practice Address - State:WI
Practice Address - Zip Code:53038-9702
Practice Address - Country:US
Practice Address - Phone:920-699-2811
Practice Address - Fax:920-699-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44216900Medicaid