Healthcare Provider Details

I. General information

NPI: 1427103670
Provider Name (Legal Business Name): COMMUNITY R-VI SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35063 HIGHWAY BB
LADDONIA MO
63352-3017
US

IV. Provider business mailing address

35063 HIGHWAY BB
LADDONIA MO
63352-3017
US

V. Phone/Fax

Practice location:
  • Phone: 573-492-6223
  • Fax: 573-492-6268
Mailing address:
  • Phone: 573-492-6223
  • Fax: 573-492-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier506145903
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name: MRS. CHERYL A MACK
Title or Position: SUPERINTENDENT
Credential:
Phone: 855-708-7567