Healthcare Provider Details

I. General information

NPI: 1699819763
Provider Name (Legal Business Name): DE LEON ISD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S HOUSTON ST
DE LEON TX
76444-2708
US

IV. Provider business mailing address

601 S HOUSTON ST
DE LEON TX
76444-2708
US

V. Phone/Fax

Practice location:
  • Phone: 254-893-5095
  • Fax: 254-893-3101
Mailing address:
  • Phone: 254-893-5095
  • Fax: 254-893-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANGELA D WHITE
Title or Position: DIRECTOR OF BUSINESS SERVICES
Credential:
Phone: 254-893-5095