Provider Demographics
NPI:1548354103
Name:DOUGLAS COUNTY SCHOOL DISTRICT (REEDSPORT) 105
Entity type:Organization
Organization Name:DOUGLAS COUNTY SCHOOL DISTRICT (REEDSPORT) 105
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:STULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-271-3656
Mailing Address - Street 1:100 RANCH RAOD
Mailing Address - Street 2:
Mailing Address - City:REEDSPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97467
Mailing Address - Country:US
Mailing Address - Phone:541-271-3656
Mailing Address - Fax:541-271-3658
Practice Address - Street 1:100 RANCH RAOD
Practice Address - Street 2:
Practice Address - City:REEDSPORT
Practice Address - State:OR
Practice Address - Zip Code:97467
Practice Address - Country:US
Practice Address - Phone:541-271-3656
Practice Address - Fax:541-271-3658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR126776Medicaid