Provider Demographics
NPI:1104996784
Name:INDEPENDENT SCHOOL DISTRICT NO 22
Entity type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT NO 22
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FROKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-847-9271
Mailing Address - Street 1:702 LAKE AVE
Mailing Address - Street 2:PO BOX 766
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3016
Mailing Address - Country:US
Mailing Address - Phone:218-847-9271
Mailing Address - Fax:218-847-9273
Practice Address - Street 1:702 LAKE AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3016
Practice Address - Country:US
Practice Address - Phone:218-847-9271
Practice Address - Fax:218-847-9273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN498923600251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN498923600OtherMA ID NUMBER