Provider Demographics
NPI:1114129723
Name:BEAUMONT USD
Entity Type:Organization
Organization Name:BEAUMONT USD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPEC. ED.
Authorized Official - Prefix:
Authorized Official - First Name:AVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STUART-BOARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-845-2681
Mailing Address - Street 1:500 GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2156
Mailing Address - Country:US
Mailing Address - Phone:909-845-1631
Mailing Address - Fax:909-845-2039
Practice Address - Street 1:500 GRACE AVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-2156
Practice Address - Country:US
Practice Address - Phone:909-845-1631
Practice Address - Fax:909-845-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS3366993Medicaid