1952501603 NPI number — GANADO UNIFIED SCHOOL DISTRICT #20

Table of content: (NPI 1952501603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952501603 NPI number — GANADO UNIFIED SCHOOL DISTRICT #20

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GANADO UNIFIED SCHOOL DISTRICT #20
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:
EXCEPTIONAL STUDENT SERVICES
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:
1952501603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1757
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GANADO
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86505-1757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-755-1024
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HWY 264 & US 191
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GANADO
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-755-1024
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOYD
Authorized Official First Name:
CLARINA
Authorized Official Middle Name:
Authorized Official Title or Position:
COORDINATOR
Authorized Official Telephone Number:
928-755-1031

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , 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: 768575 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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