Healthcare Provider Details

I. General information

NPI: 1114939139
Provider Name (Legal Business Name): SAN JUAN SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N MAIN ST
BLANDING UT
84511-3600
US

IV. Provider business mailing address

200 N MAIN ST
BLANDING UT
84511-3600
US

V. Phone/Fax

Practice location:
  • Phone: 435-678-1803
  • Fax: 435-678-1390
Mailing address:
  • Phone: 435-678-1803
  • Fax: 435-678-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberN/A
License Number State

VII. Legacy identifiers

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

# 1
Identifier876000545628
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name: MR. ANTHONY DONE
Title or Position: SPECIAL EDUCATION DIRECTOR
Credential: M.ED.
Phone: 435-678-1222