Provider Demographics
NPI:1649451386
Name:GILMANTON SCHOOL DISTRICT
Entity type:Organization
Organization Name:GILMANTON SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-946-3158
Mailing Address - Street 1:S 889 LARSON ROAD
Mailing Address - Street 2:
Mailing Address - City:GILMANTON
Mailing Address - State:WI
Mailing Address - Zip Code:54743
Mailing Address - Country:US
Mailing Address - Phone:715-946-3158
Mailing Address - Fax:715-946-3474
Practice Address - Street 1:889 LARSON ROAD
Practice Address - Street 2:
Practice Address - City:GILMANTON
Practice Address - State:WI
Practice Address - Zip Code:54743-0028
Practice Address - Country:US
Practice Address - Phone:715-946-3158
Practice Address - Fax:715-946-3474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44232600Medicaid