Provider Demographics
NPI:1730353087
Name:SCHOOL DISTRICT OF COCHRANE-FOUNTAIN CITY
Entity type:Organization
Organization Name:SCHOOL DISTRICT OF COCHRANE-FOUNTAIN CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-687-7771
Mailing Address - Street 1:S2770 STATE ROAD 35
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN CITY
Mailing Address - State:WI
Mailing Address - Zip Code:54629-7910
Mailing Address - Country:US
Mailing Address - Phone:608-687-7771
Mailing Address - Fax:608-687-3312
Practice Address - Street 1:S2770 STATE ROAD 35
Practice Address - Street 2:
Practice Address - City:FOUNTAIN CITY
Practice Address - State:WI
Practice Address - Zip Code:54629-7910
Practice Address - Country:US
Practice Address - Phone:608-687-7771
Practice Address - Fax:608-687-3312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44243700Medicaid