Healthcare Provider Details

I. General information

NPI: 1124034087
Provider Name (Legal Business Name): ROYAL SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 WILD FLOWER ST. NE
ROYAL CITY WA
99357-0486
US

IV. Provider business mailing address

230 WILD FLOWER ST. NE PO BOX 486
ROYAL CITY WA
99357-0486
US

V. Phone/Fax

Practice location:
  • Phone: 509-346-2206
  • Fax: 509-346-2207
Mailing address:
  • Phone: 509-346-2206
  • Fax: 509-346-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHERYL PROKOP
Title or Position: BUSINESS MANAGER
Credential:
Phone: 509-346-2222