Provider Demographics
NPI:1194906115
Name:MAPLE SCHOOL DISTRICT
Entity type:Organization
Organization Name:MAPLE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-363-2431
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MAPLE
Mailing Address - State:WI
Mailing Address - Zip Code:54854-0188
Mailing Address - Country:US
Mailing Address - Phone:715-363-2431
Mailing Address - Fax:715-363-2191
Practice Address - Street 1:4751 SOUTH HIGH SCHOOL LOOP ROAD
Practice Address - Street 2:
Practice Address - City:MAPLE
Practice Address - State:WI
Practice Address - Zip Code:54854-0188
Practice Address - Country:US
Practice Address - Phone:715-363-2431
Practice Address - Fax:715-363-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44230600Medicaid