Provider Demographics
NPI:1871539254
Name:COPPER COUNTRY INTERMEDIATE SCHOOL DISTRICT
Entity type:Organization
Organization Name:COPPER COUNTRY INTERMEDIATE SCHOOL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER, CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-482-4250
Mailing Address - Street 1:809 HECLA ST
Mailing Address - Street 2:PO BOX 270
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1212
Mailing Address - Country:US
Mailing Address - Phone:906-482-4250
Mailing Address - Fax:906-482-1931
Practice Address - Street 1:809 HECLA ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1212
Practice Address - Country:US
Practice Address - Phone:906-482-4250
Practice Address - Fax:906-482-1931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
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
MI3032637Medicaid