Provider Demographics
NPI:1235286675
Name:INDEPENDENCE C.S.D.
Entity type:Organization
Organization Name:INDEPENDENCE C.S.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EMBRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-334-7400
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-0900
Mailing Address - Country:US
Mailing Address - Phone:319-334-7400
Mailing Address - Fax:
Practice Address - Street 1:1207 1ST ST W
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-2375
Practice Address - Country:US
Practice Address - Phone:319-334-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0423301Medicaid