Provider Demographics
NPI:1912936717
Name:CAPE FLATTERY SCHOOL DISTRICT #401
Entity type:Organization
Organization Name:CAPE FLATTERY SCHOOL DISTRICT #401
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:360-963-2056
Mailing Address - Street 1:13193 HIGHWAY 112
Mailing Address - Street 2:PO BOX 109
Mailing Address - City:SEKIU
Mailing Address - State:WA
Mailing Address - Zip Code:98381
Mailing Address - Country:US
Mailing Address - Phone:360-963-2068
Mailing Address - Fax:360-963-2373
Practice Address - Street 1:13193 HIGHWAY 112
Practice Address - Street 2:
Practice Address - City:SEKIU
Practice Address - State:WA
Practice Address - Zip Code:98381
Practice Address - Country:US
Practice Address - Phone:360-963-2068
Practice Address - Fax:360-963-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7442064Medicaid