Healthcare Provider Details

I. General information

NPI: 1679693964
Provider Name (Legal Business Name): CEDARVILLE HIGH SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 PIRATES POINT
CEDARVILLE AR
72932
US

IV. Provider business mailing address

9500 PIRATES POINT
CEDARVILLE AR
72932
US

V. Phone/Fax

Practice location:
  • Phone: 479-474-6136
  • Fax:
Mailing address:
  • Phone: 479-474-6136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARON BRASHER
Title or Position: SPECIAL EDUCATION LEA
Credential:
Phone: 479-474-6136