Healthcare Provider Details

I. General information

NPI: 1881803682
Provider Name (Legal Business Name): GRENADA SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PENDER DR
GRENADA MS
38901-9312
US

IV. Provider business mailing address

P. O. BOX 1940
GRENADA MS
38902-1940
US

V. Phone/Fax

Practice location:
  • Phone: 662-226-8900
  • Fax: 662-227-4497
Mailing address:
  • Phone: 662-226-1606
  • Fax: 662-226-7994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR665843
License Number StateMS

VIII. Authorized Official

Name: DR. DAVID DAIGNEAULT
Title or Position: SUPERINTENDENT
Credential:
Phone: 662-226-1606