Provider Demographics
NPI:1871607655
Name:WILBUR SCHOOL DISTRICT
Entity type:Organization
Organization Name:WILBUR SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-647-2221
Mailing Address - Street 1:PO BOX 1090
Mailing Address - Street 2:202 POPE STREET
Mailing Address - City:WILBUR
Mailing Address - State:WA
Mailing Address - Zip Code:99185-1090
Mailing Address - Country:US
Mailing Address - Phone:509-647-2221
Mailing Address - Fax:
Practice Address - Street 1:202 POPE STREET
Practice Address - Street 2:
Practice Address - City:WILBUR
Practice Address - State:WA
Practice Address - Zip Code:99185-1090
Practice Address - Country:US
Practice Address - Phone:509-647-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7441199Medicaid