Provider Demographics
NPI:1619053378
Name:SPECIAL SCHOOL DISTRICT #1
Entity type:Organization
Organization Name:SPECIAL SCHOOL DISTRICT #1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIR.OF SPECIAL EDUCATION
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-668-5401
Mailing Address - Street 1:1250 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-2533
Mailing Address - Country:US
Mailing Address - Phone:612-668-5401
Mailing Address - Fax:612-668-5446
Practice Address - Street 1:1250 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-2533
Practice Address - Country:US
Practice Address - Phone:612-668-5401
Practice Address - Fax:612-668-5446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN476755100Medicaid