Healthcare Provider Details

I. General information

NPI: 1205161817
Provider Name (Legal Business Name): WHITE RIVER UNIFIED SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 FT. APACHE RD.
FT. APACHE AZ
85941
US

IV. Provider business mailing address

P.O. BOX 2114
APACHE JUNCTION AZ
85117-2114
US

V. Phone/Fax

Practice location:
  • Phone: 928-338-1353
  • Fax:
Mailing address:
  • Phone: 480-671-9318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number523629161/2233170
License Number StateAZ

VIII. Authorized Official

Name: MS. MARY KLINE
Title or Position: ASSISTANT SUPERINTENDENT
Credential:
Phone: 928-338-4842