Provider Demographics
NPI:1093736241
Name:KAHLOTUS SCHOOL DISTRICT
Entity type:Organization
Organization Name:KAHLOTUS SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL ED DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:CRESTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-282-3338
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:100 W MARTIN STREET
Mailing Address - City:KAHLOTUS
Mailing Address - State:WA
Mailing Address - Zip Code:99335
Mailing Address - Country:US
Mailing Address - Phone:509-282-3338
Mailing Address - Fax:509-282-3339
Practice Address - Street 1:100 W MARTIN STREET
Practice Address - Street 2:
Practice Address - City:KAHLOTUS
Practice Address - State:WA
Practice Address - Zip Code:99335
Practice Address - Country:US
Practice Address - Phone:509-282-3338
Practice Address - Fax:509-282-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
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
WA7440654Medicaid