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General NPI Number Information
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NPI Number | 1023610391
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Entity Type | Organization
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Legal Business Name | HAYDEN CANYON CHARTER
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Dates
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Enumeration Date | 11/12/2020
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 13590 N GOVERNMENT WAY
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City | HAYDEN
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State | ID
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Zip | 83835-7800
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Country | US
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Telephone | 208-477-1812
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Fax |
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Provider Business Mailing Address
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Address Line | 13590 N GOVERNMENT WAY
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City | HAYDEN
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State | ID
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Zip | 83835-7800
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Country | US
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Telephone | 208-477-1812
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Fax |
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Authorized Official
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Title or Position | MEDICAID BILLER
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Name | LORI ALDRICH
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Credential |
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Telephone | 208-477-1812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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