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General NPI Number Information
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NPI Number | 1891843280
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Entity Type | Organization
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Legal Business Name | CARBON COUNTY SCHOOL DISTRICT
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 755 N CEDAR HILLS DR
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City | PRICE
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State | UT
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Zip | 84501-2045
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Country | US
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Telephone | 435-637-9150
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Fax | 435-637-0714
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Provider Business Mailing Address
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Address Line | 755 N CEDAR HILLS DR
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City | PRICE
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State | UT
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Zip | 84501-2045
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Country | US
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Telephone | 435-637-9150
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Fax | 435-637-0714
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Authorized Official
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Title or Position | PRINCIPAL
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Name | MR. MICHAEL CLARK KELLER
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Credential | M. ED.
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Telephone | 435-637-9150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | A00934
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License Number State | UT
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