Provider Demographics
NPI:1861421646
Name:BAINBRIDGE ISLAND SCHOOL DISTRICT
Entity type:Organization
Organization Name:BAINBRIDGE ISLAND SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. SUPERINTENDENT I. SUPPORT SER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-780-1069
Mailing Address - Street 1:8489 MADISON AVE NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2915
Mailing Address - Country:US
Mailing Address - Phone:206-842-2907
Mailing Address - Fax:206-780-1089
Practice Address - Street 1:8489 MADISON AVE NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2915
Practice Address - Country:US
Practice Address - Phone:206-842-2907
Practice Address - Fax:206-780-1089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7440837Medicaid