Provider Demographics
NPI:1386809804
Name:MISSISSINEWA COMMUNITY SCHOOL DISTRICT
Entity type:Organization
Organization Name:MISSISSINEWA COMMUNITY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OP DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-674-8528
Mailing Address - Street 1:424 E SOUTH A ST
Mailing Address - Street 2:
Mailing Address - City:GAS CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46933-1902
Mailing Address - Country:US
Mailing Address - Phone:765-674-8528
Mailing Address - Fax:765-674-8529
Practice Address - Street 1:424 E SOUTH A ST
Practice Address - Street 2:
Practice Address - City:GAS CITY
Practice Address - State:IN
Practice Address - Zip Code:46933-1902
Practice Address - Country:US
Practice Address - Phone:765-674-8528
Practice Address - Fax:765-674-8529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100094550AMedicaid