Provider Demographics
NPI:1114048881
Name:COUNTY OF JEROME
Entity Type:Organization
Organization Name:COUNTY OF JEROME
Other - Org Name:VALLEY SCHOOL DISTRICT 262
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:208-829-5333
Mailing Address - Street 1:882 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HAZELTON
Mailing Address - State:ID
Mailing Address - Zip Code:83335-5050
Mailing Address - Country:US
Mailing Address - Phone:208-829-5353
Mailing Address - Fax:208-829-5548
Practice Address - Street 1:882 VALLEY RD
Practice Address - Street 2:
Practice Address - City:HAZELTON
Practice Address - State:ID
Practice Address - Zip Code:83335-5050
Practice Address - Country:US
Practice Address - Phone:208-829-5353
Practice Address - Fax:208-829-5548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8052680Medicaid