Provider Demographics
NPI:1548433584
Name:SPARTA AREA SCHOOL DISTRICT
Entity type:Organization
Organization Name:SPARTA AREA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF PUPIL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:JADACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-366-3456
Mailing Address - Street 1:506 N BLACK RIVER ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-1548
Mailing Address - Country:US
Mailing Address - Phone:608-366-3456
Mailing Address - Fax:608-366-3475
Practice Address - Street 1:506 N BLACK RIVER ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-1548
Practice Address - Country:US
Practice Address - Phone:608-366-3456
Practice Address - Fax:608-366-3475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44211200Medicaid