Provider Demographics
NPI:1306993456
Name:BENTON COMMUNITY SCHOOL
Entity type:Organization
Organization Name:BENTON COMMUNITY SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:EMBRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-228-8701
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:VAN HORNE
Mailing Address - State:IA
Mailing Address - Zip Code:52346-0070
Mailing Address - Country:US
Mailing Address - Phone:319-228-8701
Mailing Address - Fax:319-228-8874
Practice Address - Street 1:304 1ST STREET
Practice Address - Street 2:
Practice Address - City:VAN HORNE
Practice Address - State:IA
Practice Address - Zip Code:52346-0070
Practice Address - Country:US
Practice Address - Phone:319-228-8701
Practice Address - Fax:319-228-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA060609251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0282004Medicaid