Healthcare Provider Details

I. General information

NPI: 1730216839
Provider Name (Legal Business Name): MOHAVE VALLEY ELEM. SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1797 LA ENTRADA DR
FORT MOHAVE AZ
86426-9379
US

IV. Provider business mailing address

8450 SOUTH OLIVE DR.
MOHAVE VALLEY AZ
86440
US

V. Phone/Fax

Practice location:
  • Phone: 928-704-3600
  • Fax:
Mailing address:
  • Phone: 928-768-2507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN087148
License Number StateAZ

VIII. Authorized Official

Name: PHILIP SAUCEMAN
Title or Position: SCHOOL SUPERINTENDENT
Credential:
Phone: 928-768-2507