Healthcare Provider Details

I. General information

NPI: 1891843280
Provider Name (Legal Business Name): CARBON COUNTY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 N CEDAR HILLS DR
PRICE UT
84501-2045
US

IV. Provider business mailing address

755 N CEDAR HILLS DR
PRICE UT
84501-2045
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-9150
  • Fax: 435-637-0714
Mailing address:
  • Phone: 435-637-9150
  • Fax: 435-637-0714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberA00934
License Number StateUT

VIII. Authorized Official

Name: MR. MICHAEL CLARK KELLER
Title or Position: PRINCIPAL
Credential: M. ED.
Phone: 435-637-9150