Provider Demographics
NPI:1689742660
Name:NASELLE-GRAYS RIVER VALLEY SCHOOL DISTRICT
Entity type:Organization
Organization Name:NASELLE-GRAYS RIVER VALLEY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR-SPEC. EDUC. COOPERATIVE
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-750-7500
Mailing Address - Street 1:HCR 78 BOX 471-S
Mailing Address - Street 2:
Mailing Address - City:NASELLE
Mailing Address - State:WA
Mailing Address - Zip Code:98638-8541
Mailing Address - Country:US
Mailing Address - Phone:206-484-7121
Mailing Address - Fax:
Practice Address - Street 1:HCR 78 BOX 471-S
Practice Address - Street 2:
Practice Address - City:NASELLE
Practice Address - State:WA
Practice Address - Zip Code:98638-8541
Practice Address - Country:US
Practice Address - Phone:206-484-7121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
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
WA7442924Medicaid