Provider Demographics
NPI:1437298890
Name:JOINT SCHOOL DISTRICT 60
Entity type:Organization
Organization Name:JOINT SCHOOL DISTRICT 60
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-357-3411
Mailing Address - Street 1:545 SEMINARY AVE
Mailing Address - Street 2:
Mailing Address - City:SHELLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83274-1461
Mailing Address - Country:US
Mailing Address - Phone:208-357-3411
Mailing Address - Fax:208-357-5741
Practice Address - Street 1:545 SEMINARY AVE
Practice Address - Street 2:
Practice Address - City:SHELLEY
Practice Address - State:ID
Practice Address - Zip Code:83274-1461
Practice Address - Country:US
Practice Address - Phone:208-357-5125
Practice Address - Fax:208-357-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8050947Medicaid