Provider Demographics
NPI:1114077310
Name:SUPERINTENDENT OF BOONEVILLE HIGH SCHOOL
Entity Type:Organization
Organization Name:SUPERINTENDENT OF BOONEVILLE HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEA SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-438-0427
Mailing Address - Street 1:381 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927-3101
Mailing Address - Country:US
Mailing Address - Phone:479-675-3504
Mailing Address - Fax:479-675-3186
Practice Address - Street 1:381 W 7TH ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72927-3101
Practice Address - Country:US
Practice Address - Phone:479-675-3504
Practice Address - Fax:479-675-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159073791Medicaid
AR162892761OtherVISION AND HEARING
AR234902743OtherTHERAPIES
AR162749732OtherPERSONAL CARE