Provider Demographics
NPI:1427265677
Name:SOUTH PUTNAM COMMUNITY SCHOOL CORPORATION
Entity type:Organization
Organization Name:SOUTH PUTNAM COMMUNITY SCHOOL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BERNHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-653-3119
Mailing Address - Street 1:3999 S US HIGHWAY 231
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-8703
Mailing Address - Country:US
Mailing Address - Phone:765-653-3119
Mailing Address - Fax:765-653-7476
Practice Address - Street 1:3999 S US HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-8703
Practice Address - Country:US
Practice Address - Phone:765-653-3119
Practice Address - Fax:765-653-7476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN100473010A251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100473010AMedicaid