Provider Demographics
NPI:1861681751
Name:ROSHOLT SCHOOL DISTRICT 54 4
Entity type:Organization
Organization Name:ROSHOLT SCHOOL DISTRICT 54 4
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:G
Authorized Official - Last Name:EIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-537-4283
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:202 FINLEY AVENUE
Mailing Address - City:ROSHOLT
Mailing Address - State:SD
Mailing Address - Zip Code:57260-0106
Mailing Address - Country:US
Mailing Address - Phone:605-537-4283
Mailing Address - Fax:605-537-4285
Practice Address - Street 1:202 FINLEY AVE
Practice Address - Street 2:
Practice Address - City:ROSHOLT
Practice Address - State:SD
Practice Address - Zip Code:57260-0106
Practice Address - Country:US
Practice Address - Phone:605-537-4283
Practice Address - Fax:605-537-4285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5152170Medicaid