1790849073 NPI number — HENDRY COUNTY SCHOOL BOARD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790849073 NPI number — HENDRY COUNTY SCHOOL BOARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENDRY COUNTY SCHOOL BOARD
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:
Provider Other Organization Name Type Code:
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:
1790849073
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1980
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LABELLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33975-1980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 E HICKPOOCHEE AVE
Provider Second Line Business Practice Location Address:
OLD COURTHOUSE 2ND FLOOR
Provider Business Practice Location Address City Name:
LABELLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33935-5015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-674-4164
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAULKINS
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
Authorized Official Title or Position:
ESE DIRECTOR
Authorized Official Telephone Number:
863-674-4164

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008050115 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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