Provider Demographics
NPI:1447356688
Name:VAN BUREN INTERMEDIATE SCHOOL DISTRICT
Entity type:Organization
Organization Name:VAN BUREN INTERMEDIATE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:MANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-674-8091
Mailing Address - Street 1:701 S PAW PAW ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MI
Mailing Address - Zip Code:49064-9507
Mailing Address - Country:US
Mailing Address - Phone:269-674-8091
Mailing Address - Fax:269-674-8726
Practice Address - Street 1:701 S PAW PAW ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MI
Practice Address - Zip Code:49064-9507
Practice Address - Country:US
Practice Address - Phone:269-674-8091
Practice Address - Fax:269-674-8726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
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
MI2973776Medicaid