Provider Demographics
NPI:1538240155
Name:TAHOLAH SCHOOL DISTRICT
Entity type:Organization
Organization Name:TAHOLAH SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-276-4780
Mailing Address - Street 1:600 CHITWHIN DRIVE
Mailing Address - Street 2:PO BOX 249
Mailing Address - City:TAHOLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98587
Mailing Address - Country:US
Mailing Address - Phone:360-276-4729
Mailing Address - Fax:360-276-4370
Practice Address - Street 1:600 CHITWHIN DRIVE
Practice Address - Street 2:
Practice Address - City:TAHOLAH
Practice Address - State:WA
Practice Address - Zip Code:98587
Practice Address - Country:US
Practice Address - Phone:360-276-4729
Practice Address - Fax:360-276-4370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
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
WA7442718Medicaid