Provider Demographics
NPI:1316015290
Name:INDEPENDENT SCHOOL DISTRICT #881
Entity type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT #881
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:REDEMSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-963-3114
Mailing Address - Street 1:200 STATE HIGHWAY 55 EAST
Mailing Address - Street 2:BOX 820
Mailing Address - City:MAPLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55358-0820
Mailing Address - Country:US
Mailing Address - Phone:320-963-3171
Mailing Address - Fax:320-963-3170
Practice Address - Street 1:200 STATE HIGHWAY 55 EAST
Practice Address - Street 2:BOX 820
Practice Address - City:MAPLE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55358-0820
Practice Address - Country:US
Practice Address - Phone:320-963-3171
Practice Address - Fax:320-963-3170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN736128900OtherMEDICAL ASSISTANCE