Provider Demographics
NPI:1053340836
Name:BLAINE SCHOOL DISTRICT
Entity type:Organization
Organization Name:BLAINE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, FED. AND SPECIAL PROGRAMS
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSBREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-332-0722
Mailing Address - Street 1:770 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9149
Mailing Address - Country:US
Mailing Address - Phone:360-332-0722
Mailing Address - Fax:360-332-0555
Practice Address - Street 1:770 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-9149
Practice Address - Country:US
Practice Address - Phone:360-332-0722
Practice Address - Fax:360-332-0555
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
WA7441082Medicaid