Healthcare Provider Details

I. General information

NPI: 1497957096
Provider Name (Legal Business Name): BEAVER CREEK ELEMENTARY SCHOOL DISTRICT 26
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 E BEAVER CREEK RD
RIMROCK AZ
86335-6241
US

IV. Provider business mailing address

4810 E BEAVER CREEK RD
RIMROCK AZ
86335-6241
US

V. Phone/Fax

Practice location:
  • Phone: 928-567-4631
  • Fax: 928-567-5347
Mailing address:
  • Phone: 928-567-4631
  • Fax: 928-567-5347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number13-017850-M
License Number StateAZ

VIII. Authorized Official

Name: MRS. KARIN WARD
Title or Position: PRINCIPAL SUPERINTENDENT
Credential:
Phone: 928-567-4631