Healthcare Provider Details

I. General information

NPI: 1457521346
Provider Name (Legal Business Name): SHOSHONE SCHOOL DISTRICT NO. 312
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 E HIGHWAY 24
SHOSHONE ID
83352-5338
US

IV. Provider business mailing address

61 E HIGHWAY 24
SHOSHONE ID
83352-5338
US

V. Phone/Fax

Practice location:
  • Phone: 208-886-2381
  • Fax: 208-886-2038
Mailing address:
  • Phone: 208-886-2381
  • Fax: 208-886-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number312
License Number StateID

VIII. Authorized Official

Name: MRS. SHANNON HARRIS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 208-886-2381