Provider Demographics
NPI:1164575650
Name:SNOWFLAKE UNIFIED SCHOOL DISTRICT #5
Entity Type:Organization
Organization Name:SNOWFLAKE UNIFIED SCHOOL DISTRICT #5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:OLLERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-536-4156
Mailing Address - Street 1:682 SCHOOL BUS LANE
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937
Mailing Address - Country:US
Mailing Address - Phone:928-536-4156
Mailing Address - Fax:928-536-4246
Practice Address - Street 1:682 SCHOOL BUS LANE
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937
Practice Address - Country:US
Practice Address - Phone:928-536-4156
Practice Address - Fax:928-536-4246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN067159251300000X
251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ549264OtherAHCCCS