Provider Demographics
NPI:1568635274
Name:SCHOOL DISTRICT OF BLACK RIVER FALLS
Entity type:Organization
Organization Name:SCHOOL DISTRICT OF BLACK RIVER FALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-284-4357
Mailing Address - Street 1:301 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-1227
Mailing Address - Country:US
Mailing Address - Phone:715-284-4357
Mailing Address - Fax:715-284-7064
Practice Address - Street 1:301 N 4TH ST
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-1227
Practice Address - Country:US
Practice Address - Phone:715-284-4357
Practice Address - Fax:715-284-7064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44214400Medicaid