Provider Demographics
NPI:1063542546
Name:EVERGREEN SCHOOL DISTRICT 50
Entity type:Organization
Organization Name:EVERGREEN SCHOOL DISTRICT 50
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:406-751-1111
Mailing Address - Street 1:18 W EVERGREEN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2810
Mailing Address - Country:US
Mailing Address - Phone:406-751-1111
Mailing Address - Fax:406-752-2307
Practice Address - Street 1:18 W EVERGREEN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2810
Practice Address - Country:US
Practice Address - Phone:406-751-1111
Practice Address - Fax:406-752-2307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT161876Medicaid