Provider Demographics
NPI:1811176555
Name:CORNELL SCHOOL DISTRICT
Entity type:Organization
Organization Name:CORNELL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-720-2058
Mailing Address - Street 1:708 BRIDGE ST
Mailing Address - Street 2:P O BOX 517
Mailing Address - City:CORNELL
Mailing Address - State:WI
Mailing Address - Zip Code:54732-8390
Mailing Address - Country:US
Mailing Address - Phone:715-239-6463
Mailing Address - Fax:
Practice Address - Street 1:708 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CORNELL
Practice Address - State:WI
Practice Address - Zip Code:54732-8390
Practice Address - Country:US
Practice Address - Phone:715-239-6463
Practice Address - Fax:715-239-6467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44232100Medicaid