1891910675 NPI number — HUMBOLDT UNIFIED SCHOOL DISTRICT #22

Table of content: (NPI 1891910675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891910675 NPI number — HUMBOLDT UNIFIED SCHOOL DISTRICT #22

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUMBOLDT UNIFIED SCHOOL DISTRICT #22
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GROUP AHCCCS ID #551615
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891910675
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8766 E HWY 69
Provider Second Line Business Mailing Address:
SSO
Provider Business Mailing Address City Name:
PRESCOTT VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-759-4028
Provider Business Mailing Address Fax Number:
928-759-4030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8766 E HWY 69
Provider Second Line Business Practice Location Address:
ATTN DONNA THAXTON SPECIAL SERVICES OFFICE
Provider Business Practice Location Address City Name:
PRESCOTT VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-759-4028
Provider Business Practice Location Address Fax Number:
928-759-4030
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TURNER
Authorized Official First Name:
KAY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
DIRECTOR OF SPECIAL EDUCATION
Authorized Official Telephone Number:
928-759-4028

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN025333 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 551615 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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