Provider Demographics
NPI:1528120367
Name:COUNTY OF TWIN FALLS SCHOOL DISTRICT 415
Entity type:Organization
Organization Name:COUNTY OF TWIN FALLS SCHOOL DISTRICT 415
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COULTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:208-423-6387
Mailing Address - Street 1:550 MAIN STREET SOUTH
Mailing Address - Street 2:
Mailing Address - City:HANSEN
Mailing Address - State:ID
Mailing Address - Zip Code:83334
Mailing Address - Country:US
Mailing Address - Phone:208-423-6387
Mailing Address - Fax:208-423-5934
Practice Address - Street 1:550 MAIN ST S
Practice Address - Street 2:
Practice Address - City:HANSEN
Practice Address - State:ID
Practice Address - Zip Code:83334-4903
Practice Address - Country:US
Practice Address - Phone:208-423-6387
Practice Address - Fax:208-423-5934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8050943Medicaid