Healthcare Provider Details

I. General information

NPI: 1790909125
Provider Name (Legal Business Name): SUPT OF HORATIO HIGH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 ISBELL ST
HORATIO AR
71842-0435
US

IV. Provider business mailing address

PO BOX 435
HORATIO AR
71842-0435
US

V. Phone/Fax

Practice location:
  • Phone: 870-832-2341
  • Fax: 870-832-2174
Mailing address:
  • Phone: 870-832-2341
  • Fax: 870-832-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number6703
License Number StateAR

VIII. Authorized Official

Name: MRS. MELISSA D LIGGIN
Title or Position: DISTRICT TREASURER
Credential:
Phone: 870-832-2341