Provider Demographics
NPI:1306913017
Name:MINNEWASKA AREA SCHOOLS #2149
Entity type:Organization
Organization Name:MINNEWASKA AREA SCHOOLS #2149
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:F
Authorized Official - Last Name:OHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-239-4820
Mailing Address - Street 1:25122 STATE HWY 28
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334
Mailing Address - Country:US
Mailing Address - Phone:320-239-4800
Mailing Address - Fax:320-239-1360
Practice Address - Street 1:500 JOHN ST
Practice Address - Street 2:MINNEWASKA AREA SCHOOLS DAY TREATMENT PROGRAM
Practice Address - City:STARBUCK
Practice Address - State:MN
Practice Address - Zip Code:56381
Practice Address - Country:US
Practice Address - Phone:320-239-2257
Practice Address - Fax:320-239-1420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN218GIMIOtherBLUE CROSS BLUE SHIELD
MN877946500Medicaid
MN050321002OtherPRIMEWEST HEALTH SYSTEMS