Healthcare Provider Details

I. General information

NPI: 1952501603
Provider Name (Legal Business Name): GANADO UNIFIED SCHOOL DISTRICT #20
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 264 & US 191
GANADO AZ
86505
US

IV. Provider business mailing address

PO BOX 1757
GANADO AZ
86505-1757
US

V. Phone/Fax

Practice location:
  • Phone: 928-755-1024
  • Fax:
Mailing address:
  • Phone: 928-755-1024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CLARINA BOYD
Title or Position: COORDINATOR
Credential:
Phone: 928-755-1031