=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003760034
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRANGEVILLE SCHOOL DISTRICT #246
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2026
-----------------------------------------------------
Last Update Date | 02/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 714 JEFFERSON AVE
-----------------------------------------------------
City | GRANGEVILLE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83530-1545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-983-0990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 714 JEFFERSON AVE
-----------------------------------------------------
City | GRANGEVILLE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83530-1545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-983-0990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR SPECIAL EDUCATION
-----------------------------------------------------
Name | CHARLOTTE MCKINNEY
-----------------------------------------------------
Credential | MED LEADERSHIP
-----------------------------------------------------
Telephone | 208-983-0990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1000X
-----------------------------------------------------
Taxonomy Name | Student Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------