Provider Demographics
NPI:1285781906
Name:COMMUNITY SCHOOL DIST OF CHARTER OAK
Entity type:Organization
Organization Name:COMMUNITY SCHOOL DIST OF CHARTER OAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-678-3325
Mailing Address - Street 1:321 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARTER OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51439-0077
Mailing Address - Country:US
Mailing Address - Phone:712-678-3325
Mailing Address - Fax:
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARTER OAK
Practice Address - State:IA
Practice Address - Zip Code:51439-0077
Practice Address - Country:US
Practice Address - Phone:712-678-3325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0429639Medicaid