Provider Demographics
NPI:1255511556
Name:SCHOOL DISTRICT OF RHINELANDER
Entity type:Organization
Organization Name:SCHOOL DISTRICT OF RHINELANDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-365-9700
Mailing Address - Street 1:665 COOLIDGE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-2814
Mailing Address - Country:US
Mailing Address - Phone:715-365-9700
Mailing Address - Fax:715-365-9706
Practice Address - Street 1:665 COOLIDGE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-2814
Practice Address - Country:US
Practice Address - Phone:715-365-9700
Practice Address - Fax:715-365-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44219600Medicaid