Provider Demographics
NPI:1871775189
Name:UNION COUNTY COLLEGE CORNER JOINT SCHOOL DISTRICT
Entity type:Organization
Organization Name:UNION COUNTY COLLEGE CORNER JOINT SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURE
Authorized Official - Prefix:MS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-458-7471
Mailing Address - Street 1:107 S LAYMAN ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:IN
Mailing Address - Zip Code:47353-1203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 S LAYMAN ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:IN
Practice Address - Zip Code:47353-1203
Practice Address - Country:US
Practice Address - Phone:765-458-7471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========Medicaid