=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992992903
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINGUS UNION HIGH SCHOOL DISTRICT 4
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2007
-----------------------------------------------------
Last Update Date | 02/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 E FIR ST
-----------------------------------------------------
City | COTTONWOOD
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86326-4556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-649-4406
-----------------------------------------------------
Fax | 928-639-4236
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 E FIR ST
-----------------------------------------------------
City | COTTONWOOD
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86326-4556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-649-4406
-----------------------------------------------------
Fax | 928-639-4236
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPECIAL EDUCATION DIRECTOR
-----------------------------------------------------
Name | MS. TERESA G. GORDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 928-649-4476
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------