=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801088208
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST AMORY ELEMENTARY SCHOOL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2007
-----------------------------------------------------
Last Update Date | 08/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 704 111TH ST
-----------------------------------------------------
City | AMORY
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-256-2601
-----------------------------------------------------
Fax | 662-256-1643
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 704 111TH ST
-----------------------------------------------------
City | AMORY
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38821-2914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-256-2601
-----------------------------------------------------
Fax | 662-256-1643
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEALTH AND SAFETY COORDINATOR
-----------------------------------------------------
Name | MRS. SARAH L HODO
-----------------------------------------------------
Credential | R.N
-----------------------------------------------------
Telephone | 662-256-2601
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | R853749
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------